Organization
LAYTON MEDICAL SUPPLIES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BORISLAV KRESOVIC NHA (DESIGNATED DIRECTOR)
(414) 282-3634
Entity
Organization
Contact information
Practice address
5790 S 27TH ST, MILWAUKEE, WI 53221-4129
(414) 282-3634
Mailing address
5790 S 27TH ST, MILWAUKEE, WI 53221-4129
(414) 282-3634
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
Primary
004-0000158658-01
WI
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
004-0000158658-01
WI
Other
Enumeration date
08/29/2007
Last updated
11/05/2008
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