Organization
PROVIDA MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUDA TROYAK (PRESIDENT)
(847) 918-8085
Entity
Organization
Contact information
Practice address
333 IL-83 STE 206, MUNDELEIN, IL 60060-3117
(847) 918-8085
(847) 881-0301
Mailing address
333 IL-83 STE 206, MUNDELEIN, IL 60060-3117
(847) 918-8085
(847) 881-0301
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
203001360
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203001360
LICENSE
IL
Enumeration date
11/14/2011
Last updated
11/10/2025
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