Provider Demographics
NPI:1306909130
Name:PULMONARY PROVIDERS, INC.
Entity type:Organization
Organization Name:PULMONARY PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOYFERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-824-0500
Mailing Address - Street 1:3405 N KENNICOTT AVE
Mailing Address - Street 2:#B
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1470
Mailing Address - Country:US
Mailing Address - Phone:847-797-7815
Mailing Address - Fax:847-797-7816
Practice Address - Street 1:3405 N KENNICOTT AVE
Practice Address - Street 2:#B
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1470
Practice Address - Country:US
Practice Address - Phone:847-797-7815
Practice Address - Fax:847-797-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-000125332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL1161720001Medicare NSC