MEDICARE: BONE DOC SUPPLY

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

General Provider Information

NPI Number	:	1346766706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONE DOC SUPPLY

Provider Business Mailing Address
First Line	:	2547 W AUGUSTA BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4561
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2547 W AUGUSTA BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4561
Country	:	US
Telephone Number	:	773-573-7150
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. KEVIN M WILSON
Credential	:
Telephone Number	:	773-573-7150

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	08/17/2017

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Directions to “BONE DOC SUPPLY ” Practice Location

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