MEDICARE: MEDTAK LTD

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)		IL

General Provider Information

NPI Number	:	1386692507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTAK LTD

Provider Business Mailing Address
First Line	:	6464 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-2935
Country	:	US
Telephone Number	:	847-677-7240
Fax Number	:

Provider Business Practice Location Address
First Line	:	6464 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-2935
Country	:	US
Telephone Number	:	847-677-7240
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARCI HALPERT
Credential	:
Telephone Number	:	847-677-7240

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/15/2007

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Directions to “MEDTAK LTD ” Practice Location

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