Provider Demographics
NPI:1942492301
Name:MILLA MEDICAL SUPPLY LTD
Entity Type:Organization
Organization Name:MILLA MEDICAL SUPPLY LTD
Other - Org Name:MILLA MEDICAL SUPPLY LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIOUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROLOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-668-4806
Mailing Address - Street 1:1249 S MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-495-0199
Mailing Address - Fax:630-495-0189
Practice Address - Street 1:1249 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1249
Practice Address - Country:US
Practice Address - Phone:630-495-0199
Practice Address - Fax:630-495-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000795332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203000795OtherHOME MEDICAL EQUIPMENT