Provider Demographics
NPI:1801106851
Name:MIDWEST MEDIX SURGERY CENTER
Entity type:Organization
Organization Name:MIDWEST MEDIX SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAHOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-632-4435
Mailing Address - Street 1:104 CIRCLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8379
Mailing Address - Country:US
Mailing Address - Phone:630-632-4435
Mailing Address - Fax:
Practice Address - Street 1:8630 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3633
Practice Address - Country:US
Practice Address - Phone:773-767-8132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical