Provider Demographics
NPI:1760656987
Name:MTM SERVICES
Entity Type:Organization
Organization Name:MTM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:312-420-5556
Mailing Address - Street 1:1524 S SANGAMON ST UNIT 512
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2268
Mailing Address - Country:US
Mailing Address - Phone:312-850-2415
Mailing Address - Fax:312-850-2415
Practice Address - Street 1:1524 S SANGAMON ST UNIT 512
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2268
Practice Address - Country:US
Practice Address - Phone:312-850-2415
Practice Address - Fax:312-850-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy