Provider Demographics
NPI:1851849764
Name:MEDICAL MANAGEMENT INNOVATIONS, INC.
Entity Type:Organization
Organization Name:MEDICAL MANAGEMENT INNOVATIONS, INC.
Other - Org Name:MMI OF ILLINOIS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PFLEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-673-5699
Mailing Address - Street 1:3000 W ROHMANN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WEST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4842
Mailing Address - Country:US
Mailing Address - Phone:309-673-5699
Mailing Address - Fax:309-676-5771
Practice Address - Street 1:3000 W ROHMANN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-4842
Practice Address - Country:US
Practice Address - Phone:309-673-5699
Practice Address - Fax:309-676-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management