Provider Demographics
NPI:1205177037
Name:MIDTOWN MEDICAL CENTER
Entity type:Organization
Organization Name:MIDTOWN MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BURRUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:312-498-0224
Mailing Address - Street 1:1251A N CLYBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1707
Mailing Address - Country:US
Mailing Address - Phone:312-498-0224
Mailing Address - Fax:
Practice Address - Street 1:1251A N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-498-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURRUSS HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty