Provider Demographics
NPI:1437450434
Name:DATMCORP
Entity Type:Organization
Organization Name:DATMCORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:G
Authorized Official - Middle Name:
Authorized Official - Last Name:POLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-625-5289
Mailing Address - Street 1:3600 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2106
Mailing Address - Country:US
Mailing Address - Phone:708-625-5289
Mailing Address - Fax:
Practice Address - Street 1:3600 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2106
Practice Address - Country:US
Practice Address - Phone:708-625-5289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-06
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies