Healthcare Provider Details

I. General information

NPI: 1336088681
Provider Name (Legal Business Name): MGM MEDICAL EQUIPMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 W FARWELL AVE APT 1B
CHICAGO IL
60645-4861
US

IV. Provider business mailing address

2245 W FARWELL AVE APT 1B
CHICAGO IL
60645-4861
US

V. Phone/Fax

Practice location:
  • Phone: 432-293-4311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: AYUB TALATI
Title or Position: CEO
Credential:
Phone: 432-293-4311