Healthcare Provider Details

I. General information

NPI: 1720627862
Provider Name (Legal Business Name): MM INFUSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S MICHIGAN AVE UNIT 1
CHICAGO IL
60616-1209
US

IV. Provider business mailing address

16 N CARPENTER ST UNIT 4S
CHICAGO IL
60607-2199
US

V. Phone/Fax

Practice location:
  • Phone: 630-533-4028
  • Fax:
Mailing address:
  • Phone: 630-533-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MANAN TRIVEDI
Title or Position: OWNER
Credential: MD
Phone: 630-533-4028