Provider Demographics
NPI:1558119016
Name:BRACE SUPPLY LLC
Entity type:Organization
Organization Name:BRACE SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUBEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIDWAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-381-2771
Mailing Address - Street 1:3855 W ESTES AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1031
Mailing Address - Country:US
Mailing Address - Phone:954-381-2771
Mailing Address - Fax:
Practice Address - Street 1:3855 W ESTES AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1031
Practice Address - Country:US
Practice Address - Phone:954-381-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies