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General NPI Number Information
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NPI Number | 1093236861
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Entity Type | Organization
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Legal Business Name | MEDOX GROUP INC
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 07/03/2017
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Provider Practice Location Address
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Address Line | 9S180 LAKE DR APT 107
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City | WILLOWBROOK
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State | IL
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Zip | 60527-2547
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Country | US
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Telephone | 630-901-3741
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Fax |
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Provider Business Mailing Address
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Address Line | 9S180 LAKE DR APT 107
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City | WILLOWBROOK
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State | IL
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Zip | 60527-2547
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OKSANA DRABCHUK
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Credential |
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Telephone | 630-901-3741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 238000331
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License Number State | IL
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