Provider Demographics
NPI:1356074264
Name:MIDWEST PRIMARY CARE AND GERIATRICS LLC
Entity Type:Organization
Organization Name:MIDWEST PRIMARY CARE AND GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAUSHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-420-3169
Mailing Address - Street 1:1440 MAPLE AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4135
Mailing Address - Country:US
Mailing Address - Phone:708-420-3169
Mailing Address - Fax:
Practice Address - Street 1:1440 MAPLE AVE STE 4A
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4135
Practice Address - Country:US
Practice Address - Phone:708-420-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty