Provider Demographics
NPI:1538515234
Name:MIDWEST PEDIATRICS INC
Entity Type:Organization
Organization Name:MIDWEST PEDIATRICS INC
Other - Org Name:MIDWEST PEDIATRICS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICS
Authorized Official - Prefix:DR
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-QAWASMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-598-4100
Mailing Address - Street 1:7456 S STATE RD
Mailing Address - Street 2:302
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60638-6623
Mailing Address - Country:US
Mailing Address - Phone:708-598-4100
Mailing Address - Fax:708-598-0123
Practice Address - Street 1:7456 S STATE RD
Practice Address - Street 2:302
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60638-6623
Practice Address - Country:US
Practice Address - Phone:708-598-4100
Practice Address - Fax:708-598-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093184261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093184Medicaid
IL207094Medicare PIN