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General NPI Number Information
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NPI Number | 1629230024
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Entity Type | Organization
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Legal Business Name | MILLA MEDICAL SUPPLY LTD
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 1249 S MAIN STREET
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-495-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 1249 S MAIN STREET
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-495-0199
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LIOUDMILA FROLOVA
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Credential |
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Telephone | 630-495-0199
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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 | 3687-7611
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License Number State | IL
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