Organization
MED GROUP MEDICAL SUPPLIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARIKO MEKVABISHVILI (PRESIDENT)
(414) 745-3146
Entity
Organization
Contact information
Practice address
11402 N PORT WASHINGTON RD, SUITE 215, MEQUON, WI 53092-3447
(414) 745-3146
(414) 755-1763
Mailing address
11402 N PORT WASHINGTON RD, SUITE 215, MEQUON, WI 53092-3447
(414) 745-3146
(414) 755-1763
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/02/2011
Last updated
08/02/2011
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