| Organization Name: | MIRACLE MEDICAL SUPPLY AND BILLING |
| NPI Number: | 1104912138 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DMITRY FELDMAN (OWNER) |
| Mailing Address: | 175 N Milwaukee Ave Ste 300 Vernon Hills |
| State: | IL US |
| Postal Code: | 600614302 |
| Phone Number: | 8472762838 |
| Fax Number: | 8472762839 |
| NPI Enumeration Date: | 10/05/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |