Healthcare Provider Details

I. General information

NPI: 1063647329
Provider Name (Legal Business Name): CHICAGOLAND AD MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W HOMER ST #301
CHICAGO IL
60642-1280
US

IV. Provider business mailing address

1525 W HOMER ST #301
CHICAGO IL
60642-1280
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-1940
  • Fax: 773-292-1939
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID KRAUSE
Title or Position: PRESIDENT
Credential:
Phone: 773-292-1940