Provider Demographics
NPI:1689173676
Name:IDEAL MEDICAL EQUIPMENT AND SUPPLIES
Entity Type:Organization
Organization Name:IDEAL MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMO
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRITAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-501-1924
Mailing Address - Street 1:1177 N HIGHLAND AVE STE#204
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506
Mailing Address - Country:US
Mailing Address - Phone:630-501-1924
Mailing Address - Fax:
Practice Address - Street 1:1177 N HIGHLAND AVE STE#204
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-501-1924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies