Provider Demographics
NPI:1518261304
Name:MIDWEST ANTI-AGING
Entity Type:Organization
Organization Name:MIDWEST ANTI-AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-464-7212
Mailing Address - Street 1:10181 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1274
Mailing Address - Country:US
Mailing Address - Phone:815-464-7212
Mailing Address - Fax:815-464-7251
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:SUITE 930 E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-927-2491
Practice Address - Fax:312-202-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty