Provider Demographics
NPI:1275868333
Name:MEDICAL MANAGEMENT GROUP, LLC
Entity Type:Organization
Organization Name:MEDICAL MANAGEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-970-6997
Mailing Address - Street 1:647 W DEMING PLACE
Mailing Address - Street 2:#2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:647 W DEMING PL
Practice Address - Street 2:#2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2631
Practice Address - Country:US
Practice Address - Phone:617-970-6997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02706725332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies