Provider Demographics
NPI:1578861621
Name:MIDWEST HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:MIDWEST HEALTH CENTER, LLC
Other - Org Name:MIDWEST HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DMYTRIV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-858-7639
Mailing Address - Street 1:1244 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-9317
Mailing Address - Country:US
Mailing Address - Phone:312-470-6655
Mailing Address - Fax:312-470-6655
Practice Address - Street 1:1244 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9317
Practice Address - Country:US
Practice Address - Phone:312-470-6655
Practice Address - Fax:312-470-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-13
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120196261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center