Healthcare Provider Details

I. General information

NPI: 1942121884
Provider Name (Legal Business Name): MEDEQUIP DIRECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17W755 STANDISH LN
VILLA PARK IL
60181-3729
US

IV. Provider business mailing address

17W755 STANDISH LN
VILLA PARK IL
60181-3729
US

V. Phone/Fax

Practice location:
  • Phone: 224-804-8100
  • Fax:
Mailing address:
  • Phone: 224-804-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RIZWANA SHARIF
Title or Position: MANAGER
Credential:
Phone: 224-804-8100