=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881301430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROTTAM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2022
-----------------------------------------------------
Last Update Date | 03/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7244 W BENTON DR
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60423-9303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-506-8292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18315 PEACHTREE DR
-----------------------------------------------------
City | TINLEY PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60487-8652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-506-8292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROLAND OKWEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-506-8292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------