Provider Demographics
NPI:1740234384
Name:MIDWEST DIAGNOSTIC INC.
Entity Type:Organization
Organization Name:MIDWEST DIAGNOSTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:RIAZUL
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-392-6888
Mailing Address - Street 1:2600 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4098
Mailing Address - Country:US
Mailing Address - Phone:773-944-5775
Mailing Address - Fax:773-944-9779
Practice Address - Street 1:2600 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4098
Practice Address - Country:US
Practice Address - Phone:773-944-5775
Practice Address - Fax:773-944-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty