MEDICARE: VITAL MEDICAL NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203.002039	OTHER	IL	DME LICENSE

General Provider Information

NPI Number	:	1124586151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL MEDICAL NETWORK

Provider Business Mailing Address
First Line	:	PO BOX 734116
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-4116
Country	:	US
Telephone Number	:	312-462-4081
Fax Number	:	312-276-4064

Provider Business Practice Location Address
First Line	:	17 W GRAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4844
Country	:	US
Telephone Number	:	312-462-4081
Fax Number	:	312-276-4064

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. ED BAUER
Credential	:
Telephone Number	:	312-560-6151

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	11/09/2023

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Directions to “VITAL MEDICAL NETWORK ” Practice Location

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