Organization
MARVIN L. HOLLOMAN
Active
Other names
M & L Medical Supplies
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATOYA HOLLOMAN (ADMIN)
(708) 625-5681
Entity
Organization
Contact information
Practice address
425 JOLIET ST STE 125, DYER, IN 46311-1775
(708) 625-5681
Mailing address
21706 PETERSON AVE, SAUK VILLAGE, IL 60411-4438
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
69000690A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69000690A
—
IN
Enumeration date
11/17/2017
Last updated
11/17/2017
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