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General NPI Number Information
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NPI Number | 1851958466
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Entity Type | Organization
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Legal Business Name | MK ORTHO EQUIPMENT, LLC
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 1511 S INDIANA AVE UNIT G
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City | CHICAGO
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State | IL
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Zip | 60605-3358
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Country | US
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Telephone | 630-330-9596
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 S INDIANA AVE UNIT G
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City | CHICAGO
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State | IL
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Zip | 60605-3358
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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 | AUTHORIZING AGENT
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Name | KERI TARANTINO
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Credential |
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Telephone | 913-526-5282
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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 |
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