Provider Demographics
NPI:1356307755
Name:MIDWEST UROLOGICAL GROUP, LTD.
Entity Type:Organization
Organization Name:MIDWEST UROLOGICAL GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-673-7349
Mailing Address - Street 1:214 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-4318
Mailing Address - Country:US
Mailing Address - Phone:309-673-7349
Mailing Address - Fax:309-673-1001
Practice Address - Street 1:214 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4309
Practice Address - Country:US
Practice Address - Phone:309-673-7349
Practice Address - Fax:309-673-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE18288Medicare UPIN
ILL02696Medicare ID - Type Unspecified