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General NPI Number Information
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NPI Number | 1407800899
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Entity Type | Organization
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Legal Business Name | DME INC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 9625 S COLFAX AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4900
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Country | US
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Telephone | 773-416-3800
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Fax | 773-728-6853
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Provider Business Mailing Address
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Address Line | 9625 S COLFAX AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4900
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Country | US
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Telephone | 773-416-3800
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Fax | 773-728-6853
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARIA G THANUGUNDLA
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Credential |
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Telephone | 773-416-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 203.000741
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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