Provider Demographics
NPI:1881862290
Name:MIDWEST PRACTIONERS, LLC
Entity type:Organization
Organization Name:MIDWEST PRACTIONERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:513-515-1751
Mailing Address - Street 1:9920 CEDAR VIEW LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-9466
Mailing Address - Country:US
Mailing Address - Phone:513-515-1751
Mailing Address - Fax:
Practice Address - Street 1:7800 JANDARACRES DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2032
Practice Address - Country:US
Practice Address - Phone:513-515-1751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9353221Medicare PIN