Healthcare Provider Details

I. General information

NPI: 1821584574
Provider Name (Legal Business Name): WILLIS DURABLE MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 ESSEX ST
ALGONQUIN IL
60102-5301
US

IV. Provider business mailing address

1363 ESSEX ST
ALGONQUIN IL
60102-5301
US

V. Phone/Fax

Practice location:
  • Phone: 224-575-2118
  • Fax:
Mailing address:
  • Phone: 224-575-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DAWN LYN WILLIS
Title or Position: CEO
Credential:
Phone: 224-575-2118