Provider Demographics
NPI:1912040221
Name:MIDWEST MEDICAL SUPPLY & EQUIPMENT, INC.
Entity Type:Organization
Organization Name:MIDWEST MEDICAL SUPPLY & EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAJANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-729-1102
Mailing Address - Street 1:1152 S. MAYFIELD ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-5356
Mailing Address - Country:US
Mailing Address - Phone:773-729-1102
Mailing Address - Fax:708-449-7962
Practice Address - Street 1:1152 SOUTH MAYFIELD STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5356
Practice Address - Country:US
Practice Address - Phone:773-729-1102
Practice Address - Fax:708-449-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies