Provider Demographics
NPI:1598074163
Name:MIDWEST INTERNAL MEDICINE CLINIC INC
Entity Type:Organization
Organization Name:MIDWEST INTERNAL MEDICINE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-885-3500
Mailing Address - Street 1:1555 BARRINGTON RD
Mailing Address - Street 2:SUITE 210 BLDG ONE
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1019
Mailing Address - Country:US
Mailing Address - Phone:847-885-3500
Mailing Address - Fax:847-686-0070
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:SUITE 210 BLDG ONE
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-885-3500
Practice Address - Fax:847-686-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty