Provider Demographics
NPI:1275807869
Name:MIDWEST MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-321-8662
Mailing Address - Street 1:12093 W MORGAN OAK DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1035
Mailing Address - Country:US
Mailing Address - Phone:414-321-8662
Mailing Address - Fax:414-306-7002
Practice Address - Street 1:12093 W MORGAN OAK DR
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1035
Practice Address - Country:US
Practice Address - Phone:414-321-8662
Practice Address - Fax:414-306-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty