MEDICARE: JUNIOR MEDIC 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		IL

General Provider Information

NPI Number	:	1881983146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNIOR MEDIC LLC

Provider Business Mailing Address
First Line	:	3029 E 92ND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4500
Country	:	US
Telephone Number	:	773-382-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	3029 E 92ND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4500
Country	:	US
Telephone Number	:	773-382-0211
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JOHN MWESIGWA
Credential	:	RN
Telephone Number	:	773-382-0211

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/07/2011

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