Healthcare Provider Details

I. General information

NPI: 1700873973
Provider Name (Legal Business Name): CEM MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 N VIRGINIA AVE
CHICAGO IL
60625-3918
US

IV. Provider business mailing address

5530 N VIRGINIA AVE
CHICAGO IL
60625-3918
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-4566
  • Fax: 773-293-0948
Mailing address:
  • Phone: 773-654-1812
  • Fax: 773-439-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1574401
License Number StateIL

VIII. Authorized Official

Name: MR. PETER B MIGELY
Title or Position: MANAGING PARTNER
Credential:
Phone: 773-654-1812