Provider Demographics
NPI:1700873973
Name:CEM MEDICAL LLC
Entity type:Organization
Organization Name:CEM MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:MIGELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-654-1812
Mailing Address - Street 1:5530 N VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3918
Mailing Address - Country:US
Mailing Address - Phone:773-654-1812
Mailing Address - Fax:773-439-6350
Practice Address - Street 1:5530 N VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3918
Practice Address - Country:US
Practice Address - Phone:773-293-4566
Practice Address - Fax:773-293-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IL1574401332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635096OtherBC
IN300091329Medicaid
=========OtherPHCS
IL01635096OtherBC