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General NPI Number Information
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NPI Number | 1942492301
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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 | 08/09/2007
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 1249 S. MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-1249
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Country | US
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Telephone | 630-495-0199
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Fax | 630-495-0189
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Provider Business Mailing Address
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Address Line | 1249 S MAIN ST.
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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 | 630-495-0189
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Authorized Official
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Title or Position | OWNER
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Name | MS. LIOUDMILA FROLOVA
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Credential |
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Telephone | 847-668-4806
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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 | 203000795
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License Number State | IL
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