Provider Demographics
NPI:1730305756
Name:MIDWEST IMMEDIATE CARE LLC
Entity Type:Organization
Organization Name:MIDWEST IMMEDIATE CARE LLC
Other - Org Name:SCHAUMBURG IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:VASEEMUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-891-6850
Mailing Address - Street 1:1375 E SCHAUMBURG RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3643
Mailing Address - Country:US
Mailing Address - Phone:847-891-6850
Mailing Address - Fax:847-891-6666
Practice Address - Street 1:1375 E SCHAUMBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3643
Practice Address - Country:US
Practice Address - Phone:847-891-6850
Practice Address - Fax:847-891-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213215Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER