Provider Demographics
NPI:1538306063
Name:MIDWEST MEDICAL CARE
Entity Type:Organization
Organization Name:MIDWEST MEDICAL CARE
Other - Org Name:SHIFA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AFSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFIZ-AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-351-0775
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-351-0775
Mailing Address - Fax:630-307-8021
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-351-0775
Practice Address - Fax:630-307-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104408Medicaid
IL036104408Medicaid
K13480Medicare Oscar/Certification