MEDICARE: EMINERE HAIR LLC

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
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1184418113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMINERE HAIR LLC

Provider Business Mailing Address
First Line	:	2618 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2302
Country	:	US
Telephone Number	:	312-523-8270
Fax Number	:	312-523-8270

Provider Business Practice Location Address
First Line	:	2618 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2302
Country	:	US
Telephone Number	:	312-523-8270
Fax Number	:	312-523-8270

Authorized Official
Title or Position	:	CRANIAL PROSTHESES
Name	:	MARLENE DAVID
Credential	:	CRANIAL PROSTHESES
Telephone Number	:	312-523-8270

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	03/26/2026

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Directions to “EMINERE HAIR LLC ” Practice Location

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