Provider Demographics
NPI:1578621538
Name:MIRUS INC.
Entity Type:Organization
Organization Name:MIRUS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKHNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-803-1373
Mailing Address - Street 1:9737 N FOX GLEN DR
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5811
Mailing Address - Country:US
Mailing Address - Phone:847-803-1373
Mailing Address - Fax:
Practice Address - Street 1:9737 N FOX GLEN DR
Practice Address - Street 2:SUITE 4C
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5811
Practice Address - Country:US
Practice Address - Phone:847-803-1373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-60714-01Medicaid
IL=========-60714-01Medicaid