Organization
HAVANA MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERI TARANTINO JR. (AUTHORIZING AGENT)
(913) 526-5282
Entity
Organization
Contact information
Practice address
1807 SHERMAN BLVD, CRYSTAL LAKE, IL 60014-2456
(847) 875-5957
Mailing address
1807 SHERMAN BLVD, CRYSTAL LAKE, IL 60014-2456
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
10/18/2021
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