Provider Demographics
NPI:1063647329
Name:CHICAGOLAND AD MEDICAL INC
Entity Type:Organization
Organization Name:CHICAGOLAND AD MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-292-1940
Mailing Address - Street 1:1525 W HOMER ST
Mailing Address - Street 2:#301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-1280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1525 W HOMER ST
Practice Address - Street 2:#301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-1280
Practice Address - Country:US
Practice Address - Phone:773-292-1940
Practice Address - Fax:773-292-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies