Provider Demographics
NPI:1205393972
Name:MIDWEST MEDICAL LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:239-970-2484
Mailing Address - Street 1:2001 MIDWEST RD STE LL22
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1316
Mailing Address - Country:US
Mailing Address - Phone:239-970-2484
Mailing Address - Fax:239-228-8640
Practice Address - Street 1:2001 MIDWEST RD STE LL22
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1316
Practice Address - Country:US
Practice Address - Phone:239-970-2484
Practice Address - Fax:239-228-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty