Provider Demographics
NPI:1881961324
Name:UNIVERSAL MEDICAL PRODUCTS
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-596-9880
Mailing Address - Street 1:16730 RICHMOND AVE
Mailing Address - Street 2:UNIT 6
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16730 RICHMOND AVE
Practice Address - Street 2:UNIT 6
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1078
Practice Address - Country:US
Practice Address - Phone:708-596-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-001-368332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies