Healthcare Provider Details

I. General information

NPI: 1689173676
Provider Name (Legal Business Name): IDEAL MEDICAL EQUIPMENT AND SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 N HIGHLAND AVE STE#204
AURORA IL
60506
US

IV. Provider business mailing address

1177 N HIGHLAND AVE STE#204
AURORA IL
60506
US

V. Phone/Fax

Practice location:
  • Phone: 630-501-1924
  • Fax:
Mailing address:
  • Phone: 630-501-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IMO IBRITAM
Title or Position: OWNER
Credential:
Phone: 630-501-1924