=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326539396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHICMED TRANSPORTION &LOGISTICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2018
-----------------------------------------------------
Last Update Date | 05/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4325 FRONTAGE RD
-----------------------------------------------------
City | OAK FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60452-4628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-518-1548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 641
-----------------------------------------------------
City | TINLEY PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60477-0641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-518-1548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | AHMAD SHALAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-518-1548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------