Healthcare Provider Details

I. General information

NPI: 1922274521
Provider Name (Legal Business Name): DLS MEDICAL EQUIPMENT PROVIDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 N 56TH ST SUITE B165
MILWAUKEE WI
53216-1269
US

IV. Provider business mailing address

4115 N 56TH ST SUITE B165
MILWAUKEE WI
53216-1269
US

V. Phone/Fax

Practice location:
  • Phone: 414-349-1012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATINA FULLER
Title or Position: MEMBER
Credential:
Phone: 414-349-1012