Provider Demographics
NPI:1336306380
Name:MIDWEST INFUSION INC
Entity Type:Organization
Organization Name:MIDWEST INFUSION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHAULOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-569-1218
Mailing Address - Street 1:24333 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2822
Mailing Address - Country:US
Mailing Address - Phone:248-569-1218
Mailing Address - Fax:248-569-2148
Practice Address - Street 1:24333 SOUTHFIELD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2822
Practice Address - Country:US
Practice Address - Phone:248-569-1218
Practice Address - Fax:248-569-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion