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General NPI Number Information
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NPI Number | 1528245776
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Entity Type | Organization
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Legal Business Name | MIRAB MEDICAL SUPPLY
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 309 E DUNDEE RD
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City | WHEELING
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State | IL
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Zip | 60090-3107
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Country | US
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Telephone | 847-392-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 309 E DUNDEE RD
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City | WHEELING
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State | IL
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Zip | 60090-3107
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Country | US
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Telephone | 847-392-8080
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ZHANNA SHNAYDERSHTEYN
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Credential |
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Telephone | 847-392-8080
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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 |
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License Number State | IL
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