Organization
NICA MEDICAL EQUIPMENT SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTIANA UDOH (GENERAL MANAGER)
(773) 671-5162
Entity
Organization
Contact information
Practice address
28 W LAKE ST, SUITE 7, ADDISON, IL 60101-2709
(630) 628-7004
(630) 628-6106
Mailing address
28 W LAKE ST, SUITE 7, ADDISON, IL 60101-2709
(630) 628-7004
(630) 628-6106
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13803551001
—
IL
Enumeration date
05/08/2007
Last updated
01/02/2009
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