Healthcare Provider Details

I. General information

NPI: 1669803524
Provider Name (Legal Business Name): PICC LINES PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7352 LAWNDALE AVE
SKOKIE IL
60076-4022
US

IV. Provider business mailing address

7352 LAWNDALE AVE
SKOKIE IL
60076-4022
US

V. Phone/Fax

Practice location:
  • Phone: 847-626-0800
  • Fax: 847-626-0817
Mailing address:
  • Phone: 847-626-0800
  • Fax: 847-626-0817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SYED M HASAN
Title or Position: PRESIDENT
Credential:
Phone: 773-544-1249