Organization
MEDICALSUPPLY LLC
Active
Organization
MEDICALSUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ILYA BEYDER (OFFICER)
(414) 302-6337
Entity
Organization
Contact information
Practice address
8023 W NATIONAL AVE, WEST ALLIS, WI 53214-4507
(414) 302-6337
Mailing address
8023 W NATIONAL AVE, WEST ALLIS, WI 53214-4507
(414) 302-6337
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41569900
—
WI
Enumeration date
05/21/2008
Last updated
06/03/2008
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