Provider Demographics
NPI:1356486161
Name:RELIABLE MEDICAL SUPPLY OF THE MIDWEST
Entity Type:Organization
Organization Name:RELIABLE MEDICAL SUPPLY OF THE MIDWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YISHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-566-0800
Mailing Address - Street 1:200 HOWARD AVE
Mailing Address - Street 2:SUITE 246
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5906
Mailing Address - Country:US
Mailing Address - Phone:847-566-0800
Mailing Address - Fax:
Practice Address - Street 1:200 HOWARD AVE
Practice Address - Street 2:SUITE 246
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-5906
Practice Address - Country:US
Practice Address - Phone:847-566-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid