Provider Demographics
NPI:1588686513
Name:ABT SURGICAL SUPPLY CO
Entity type:Organization
Organization Name:ABT SURGICAL SUPPLY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:AKSELRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-262-1513
Mailing Address - Street 1:2805 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1501
Mailing Address - Country:US
Mailing Address - Phone:773-262-1513
Mailing Address - Fax:773-262-9853
Practice Address - Street 1:2805 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1501
Practice Address - Country:US
Practice Address - Phone:773-262-1513
Practice Address - Fax:773-262-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid