Organization
KOFFEL MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN W KOFFEL (PRESIDENT)
(847) 816-8000
Entity
Organization
Contact information
Practice address
1003 W PARK AVE, LIBERTYVILLE, IL 60048-2550
(847) 816-8000
(847) 816-8606
Mailing address
1003 W PARK AVE, LIBERTYVILLE, IL 60048-2550
Taxonomy
Speciality
Code
Description
License number
State
332BD1200X
Dialysis Equipment & Supplies (DME)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00673978X
—
GA
05
—
0440301
—
MS
05
—
0701390
—
DC
05
—
0877243
—
OH
05
—
0944694
—
IA
05
—
1531235
—
LA
05
—
3742601
—
NJ
05
—
4581798
—
TN
05
—
59379
—
ND
05
—
90002692
—
KY
Enumeration date
10/27/2005
Last updated
08/22/2020
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