Provider Demographics
NPI:1699458349
Name:MUMMYMED LTD
Entity type:Organization
Organization Name:MUMMYMED LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUTSOGIANNAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-857-3079
Mailing Address - Street 1:7358 N LINCOLN AVE
Mailing Address - Street 2:STE 170; OFC 9
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:312-857-3079
Mailing Address - Fax:
Practice Address - Street 1:7358 N LINCOLN AVE
Practice Address - Street 2:STE 170; OFC 9
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712
Practice Address - Country:US
Practice Address - Phone:312-857-3079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies