Provider Demographics
NPI:1760521355
Name:CENTRAD LLC
Entity Type:Organization
Organization Name:CENTRAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KORSLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-369-5840
Mailing Address - Street 1:184 SHUMAN BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1219
Mailing Address - Country:US
Mailing Address - Phone:630-369-5840
Mailing Address - Fax:630-369-0744
Practice Address - Street 1:184 SHUMAN BLVD
Practice Address - Street 2:STE 140
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1219
Practice Address - Country:US
Practice Address - Phone:630-369-5840
Practice Address - Fax:630-369-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition