Provider Demographics
NPI:1326210931
Name:MEDLIFE HOME MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:MEDLIFE HOME MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KANWAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FATIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-750-7099
Mailing Address - Street 1:3552 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3552 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5465
Practice Address - Country:US
Practice Address - Phone:773-750-7099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies