Healthcare Provider Details

I. General information

NPI: 1104731272
Provider Name (Legal Business Name): MGM MEDICAL EQUIPMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 W FARWELL AVE APT 1B
CHICAGO IL
60645-4861
US

IV. Provider business mailing address

2245 W FARWELL AVE APT 1B
CHICAGO IL
60645-4861
US

V. Phone/Fax

Practice location:
  • Phone: 432-293-4311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: AYUB VALI TALATI
Title or Position: MANAGER
Credential:
Phone: 432-293-4311