# MED MK LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124776661
- **Authorized official:** MAYYURATHAN KANAGGAPPAH MAHESWARA (PRESIDENT)
- **Authorized official phone:** (312) 483-3171

## Contact information

- **Practice address:** 1785 W HOWARD ST, CHICAGO, IL 60626-1626
- **Practice address phone:** (312) 483-3171
- **Mailing address:** 7120 N SHERIDAN RD APT 304, CHICAGO, IL 60626-2906
- **Mailing address phone:** (312) 483-3171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/14/2022
- **Last updated:** 03/14/2022