Healthcare Provider Details

I. General information

NPI: 1528245776
Provider Name (Legal Business Name): MIRAB MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E DUNDEE RD
WHEELING IL
60090-3107
US

IV. Provider business mailing address

309 E DUNDEE RD
WHEELING IL
60090-3107
US

V. Phone/Fax

Practice location:
  • Phone: 847-392-8080
  • Fax:
Mailing address:
  • Phone: 847-392-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. ZHANNA SHNAYDERSHTEYN
Title or Position: OWNER
Credential:
Phone: 847-392-8080