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General NPI Number Information
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NPI Number | 1821088964
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Entity Type | Organization
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Legal Business Name | KOFFEL MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1003 W PARK AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2550
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Country | US
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Telephone | 847-816-8000
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Fax | 847-816-8606
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Provider Business Mailing Address
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Address Line | 1003 W PARK AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2550
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Country | US
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Telephone |
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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. JOHN W KOFFEL
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Credential |
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Telephone | 847-816-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number |
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License Number State | IL
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