MEDICARE: MR. LES CHALFIN C-PED

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	:	1902075450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LES CHALFIN C-PED

Provider Business Mailing Address
First Line	:	1239 73RD ST
Second Line	:	SUITE G
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50311-1339
Country	:	US
Telephone Number	:	515-256-9006
Fax Number	:	515-285-9247

Provider Business Practice Location Address
First Line	:	1239 73RD ST
Second Line	:	SUITE G
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50311-1339
Country	:	US
Telephone Number	:	515-256-9006
Fax Number	:	515-285-9247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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