=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578931051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D & M MEDICAL SUPPLY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2015
-----------------------------------------------------
Last Update Date | 12/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 738 S BUFFALO GROVE RD
-----------------------------------------------------
City | BUFFALO GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60089-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-520-4901
-----------------------------------------------------
Fax | 847-243-2303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 738 S BUFFALO GROVE RD
-----------------------------------------------------
City | BUFFALO GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60089-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-520-4901
-----------------------------------------------------
Fax | 847-243-2303
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | LENA PRIDACHA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 224-578-5237
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 203.001690
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------