Healthcare Provider Details

I. General information

NPI: 1578621538
Provider Name (Legal Business Name): MIRUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9737 N FOX GLEN DR SUITE 4C
NILES IL
60714-5811
US

IV. Provider business mailing address

9737 N FOX GLEN DR SUITE 4C
NILES IL
60714-5811
US

V. Phone/Fax

Practice location:
  • Phone: 847-803-1373
  • Fax:
Mailing address:
  • Phone: 847-803-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: LEONID YAKHNES
Title or Position: DIRECTOR
Credential:
Phone: 847-803-1373