Provider Demographics
NPI:1174260111
Name:MIDWEST MEDICAL PRACTITIONERS LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANISH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JABBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-282-0380
Mailing Address - Street 1:1153 E GANNON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2611
Mailing Address - Country:US
Mailing Address - Phone:636-282-0380
Mailing Address - Fax:877-592-0806
Practice Address - Street 1:120 BOYD ST
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:MO
Practice Address - Zip Code:63020
Practice Address - Country:US
Practice Address - Phone:636-282-0380
Practice Address - Fax:877-592-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health