Healthcare Provider Details

I. General information

NPI: 1811182363
Provider Name (Legal Business Name): MIDWEST PULMONARY AND SLEEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W ADDISON ST SUITE 304
CHICAGO IL
60634-4401
US

IV. Provider business mailing address

5600 W ADDISON ST SUITE 304
CHICAGO IL
60634-4401
US

V. Phone/Fax

Practice location:
  • Phone: 773-481-1570
  • Fax: 773-481-0547
Mailing address:
  • Phone: 773-481-1570
  • Fax: 773-481-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RADA IVANOV
Title or Position: PARTNER
Credential: MD
Phone: 773-481-1570