Healthcare Provider Details

I. General information

NPI: 1407800899
Provider Name (Legal Business Name): DME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 S COLFAX AVE
CHICAGO IL
60617-4900
US

IV. Provider business mailing address

9625 S COLFAX AVE
CHICAGO IL
60617-4900
US

V. Phone/Fax

Practice location:
  • Phone: 773-416-3800
  • Fax: 773-728-6853
Mailing address:
  • Phone: 773-416-3800
  • Fax: 773-728-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203.000741
License Number StateIL

VIII. Authorized Official

Name: MRS. MARIA G THANUGUNDLA
Title or Position: PRESIDENT
Credential:
Phone: 773-416-3800