Provider Demographics
NPI:1093856932
Name:INTEGRATED SERVICES INCORPORATED OF THE MIDWEST
Entity Type:Organization
Organization Name:INTEGRATED SERVICES INCORPORATED OF THE MIDWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAUSLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-343-9393
Mailing Address - Street 1:582 N SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3739
Mailing Address - Country:US
Mailing Address - Phone:309-343-9393
Mailing Address - Fax:309-343-2107
Practice Address - Street 1:582 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3739
Practice Address - Country:US
Practice Address - Phone:309-343-9393
Practice Address - Fax:309-343-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058861207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214772Medicare PIN