Provider Demographics
NPI:1760259998
Name:MIDWEST REPRODUCTIVE HEALTH
Entity Type:Organization
Organization Name:MIDWEST REPRODUCTIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-216-5288
Mailing Address - Street 1:4236 MARAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4236 MARAY DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4964
Practice Address - Country:US
Practice Address - Phone:608-216-5288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family PlanningGroup - Single Specialty