Individual
MR. ILYA BEYDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8023 W NATIONAL AVE, WEST ALLIS, WI 53214-4507
(414) 302-6337
(414) 755-2039
Mailing address
8023 W NATIONAL AVE, WEST ALLIS, WI 53214-4507
(414) 302-6337
(414) 755-2039
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-078373
MEDICAL SUPPY
WI
Enumeration date
10/10/2006
Last updated
12/18/2007
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