Provider Demographics
NPI:1174623003
Name:MEDICAL PRODUCTS GROUP, LLC
Entity type:Organization
Organization Name:MEDICAL PRODUCTS GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAWARU
Authorized Official - Middle Name:
Authorized Official - Last Name:OMORUYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-462-6770
Mailing Address - Street 1:PO BOX 43842
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-0842
Mailing Address - Country:US
Mailing Address - Phone:630-462-6770
Mailing Address - Fax:630-462-6790
Practice Address - Street 1:214 E GENEVA RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2408
Practice Address - Country:US
Practice Address - Phone:630-462-6770
Practice Address - Fax:630-462-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000802332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL5627720001Medicare NSC