Healthcare Provider Details

I. General information

NPI: 1417934472
Provider Name (Legal Business Name): ULTIMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MELVIN DR SUITE 21
NORTHBROOK IL
60062-2018
US

IV. Provider business mailing address

310 MELVIN DR SUITE 21
NORTHBROOK IL
60062-2018
US

V. Phone/Fax

Practice location:
  • Phone: 847-509-8550
  • Fax: 847-509-8552
Mailing address:
  • Phone: 847-509-8550
  • Fax: 847-509-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL WATERS
Title or Position: OWNER
Credential:
Phone: 847-509-8550