Healthcare Provider Details

I. General information

NPI: 1578473203
Provider Name (Legal Business Name): MILA MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 MONROE ST APT 101
BELLWOOD IL
60104-2078
US

IV. Provider business mailing address

4010 MONROE ST APT 101
BELLWOOD IL
60104-2078
US

V. Phone/Fax

Practice location:
  • Phone: 879-872-4892
  • Fax: 879-872-4892
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAIS FATIMA HASSAN
Title or Position: PRESIDENT
Credential:
Phone: 879-872-4892