Healthcare Provider Details

I. General information

NPI: 1902567530
Provider Name (Legal Business Name): MIDWEST MED SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 06/24/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6224 N PULASKI RD
CHICAGO IL
60646-5114
US

IV. Provider business mailing address

6224 N PULASKI RD
CHICAGO IL
60646-5114
US

V. Phone/Fax

Practice location:
  • Phone: 224-770-0889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: VIJAY KUMAR VERMA
Title or Position: PRESIDENT
Credential:
Phone: 224-770-0889