MEDICARE: MIDWAY CLINIC SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	036-032688	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104977446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWAY CLINIC SC

Provider Business Mailing Address
First Line	:	4940 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2116
Country	:	US
Telephone Number	:	773-582-6800
Fax Number	:	773-582-1380

Provider Business Practice Location Address
First Line	:	4940 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2116
Country	:	US
Telephone Number	:	773-582-6800
Fax Number	:	773-582-1380

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. VIKTORAS DUBINSKAS
Credential	:	MD
Telephone Number	:	773-582-6800

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/28/2009

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Directions to “MIDWAY CLINIC SC ” Practice Location

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