MEDICARE: MIDWEST MEDICAL SERVICES, P.C.

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	207YX0602X	Otolaryngic Allergy Physician	R6G71	MO

General Provider Information

NPI Number	:	1578809687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST MEDICAL SERVICES, P.C.

Provider Business Mailing Address
First Line	:	1324 CLARKSON CLAYTON CTR
Second Line	:	#301
City	:	ELLISVILLE
State	:	MO
Zip	:	63011-2145
Country	:	US
Telephone Number	:	314-735-5015
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 CLARKSON CLAYTON CTR
Second Line	:	#301
City	:	ELLISVILLE
State	:	MO
Zip	:	63011-2145
Country	:	US
Telephone Number	:	314-735-5015
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL BURK
Credential	:	D.O.
Telephone Number	:	314-735-5015

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	01/15/2013

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