Provider Demographics
NPI:1790743417
Name:MIDWEST PULMONARY ASSOCIATES S.C.
Entity Type:Organization
Organization Name:MIDWEST PULMONARY ASSOCIATES S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:TU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-932-2040
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:230
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-932-2040
Mailing Address - Fax:866-932-1513
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:230
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-932-2040
Practice Address - Fax:866-932-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215074OtherBLUE SHIELD PROVIDER NUMB
IL02215074OtherBLUE SHIELD PROVIDER NUMB