Provider Demographics
NPI:1700989936
Name:MIDWEST PRIMARY CARE, S.C.
Entity Type:Organization
Organization Name:MIDWEST PRIMARY CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MOHSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-9399
Mailing Address - Street 1:2955 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2409
Mailing Address - Country:US
Mailing Address - Phone:708-425-9399
Mailing Address - Fax:708-425-9306
Practice Address - Street 1:2955 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2409
Practice Address - Country:US
Practice Address - Phone:708-425-9399
Practice Address - Fax:708-425-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01619476OtherBCBS OF IL
ILCN1470Medicare ID - Type Unspecified
IL342431Medicare ID - Type Unspecified