Provider Demographics
NPI:1750396586
Name:MIDWEST REHABILITATION ASSOCIATES LLC
Entity type:Organization
Organization Name:MIDWEST REHABILITATION ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:GULOTTA
Authorized Official - Last Name:DEPPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-2201
Mailing Address - Street 1:PO BOX 3997
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-3997
Mailing Address - Country:US
Mailing Address - Phone:815-741-2201
Mailing Address - Fax:815-741-2285
Practice Address - Street 1:2400 GLENWOOD AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5474
Practice Address - Country:US
Practice Address - Phone:815-741-2201
Practice Address - Fax:815-741-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932105OtherBC/BS
ILDA5166OtherRAIL ROAD MEDICARE
ILDA5166OtherRAIL ROAD MEDICARE