Provider Demographics
NPI:1891854360
Name:MID AMERICA PROFESSIONAL GROUP, PC
Entity Type:Organization
Organization Name:MID AMERICA PROFESSIONAL GROUP, PC
Other - Org Name:SCHOOL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-886-6639
Mailing Address - Street 1:1499 WINDHORST WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8800
Mailing Address - Country:US
Mailing Address - Phone:317-886-6639
Mailing Address - Fax:888-547-0377
Practice Address - Street 1:1499 WINDHORST WAY
Practice Address - Street 2:STE 100
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8800
Practice Address - Country:US
Practice Address - Phone:317-886-6639
Practice Address - Fax:888-547-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
IN12010530A122300000X
NC5681122300000X
IN12010734A122300000X
IN12010380A122300000X
KY5432122300000X
IN12007647A122300000X
IN12011536A122300000X
OH30019922122300000X
IN12011346A122300000X
IN12011900A122300000X
IN12010846A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty