Provider Demographics
NPI:1881043610
Name:MIDWEST GERIATRICS LLC
Entity Type:Organization
Organization Name:MIDWEST GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-245-4073
Mailing Address - Street 1:6101 S COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8132
Mailing Address - Country:US
Mailing Address - Phone:630-686-9000
Mailing Address - Fax:844-235-2578
Practice Address - Street 1:6101 S COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-8132
Practice Address - Country:US
Practice Address - Phone:630-686-9000
Practice Address - Fax:844-235-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F100323989OtherPTAN