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General NPI Number Information
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NPI Number | 1386057461
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Entity Type | Organization
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Legal Business Name | LIVE NFP
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 9016 S INDIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60619-6638
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Country | US
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Telephone | 773-419-0131
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Fax |
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Provider Business Mailing Address
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Address Line | 9016 S INDIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60619-6638
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Country | US
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Telephone | 773-419-0131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT VARNADO
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Credential |
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Telephone | 773-419-0131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | V65377255029
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License Number State | IL
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