Healthcare Provider Details

I. General information

NPI: 1437356508
Provider Name (Legal Business Name): CDM SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N50W13740 OVERVIEW DR SUITE B
MENOMONEE FALLS WI
53051-7062
US

IV. Provider business mailing address

N50W13740 OVERVIEW DR SUITE B
MENOMONEE FALLS WI
53051-7062
US

V. Phone/Fax

Practice location:
  • Phone: 262-781-7690
  • Fax: 262-781-7692
Mailing address:
  • Phone: 262-781-7690
  • Fax: 262-781-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DALE ALAN RUNGE
Title or Position: MANAGER
Credential:
Phone: 262-781-7690