Healthcare Provider Details

I. General information

NPI: 1639179526
Provider Name (Legal Business Name): PLD MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 N CALIFORNIA AVE SUITE202
CHICAGO IL
60645-5253
US

IV. Provider business mailing address

6420 N CALIFORNIA AVE SUITE202
CHICAGO IL
60645-5253
US

V. Phone/Fax

Practice location:
  • Phone: 773-465-5260
  • Fax: 773-465-5261
Mailing address:
  • Phone: 773-465-5260
  • Fax: 773-465-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK GORELIC
Title or Position: PRESIDENT
Credential:
Phone: 773-465-5260