Healthcare Provider Details

I. General information

NPI: 1003385535
Provider Name (Legal Business Name): MIDWEST EXPRESS CARE 2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3258 W 111TH ST
CHICAGO IL
60655-2729
US

IV. Provider business mailing address

40 75TH ST
WILLOWBROOK IL
60527-2325
US

V. Phone/Fax

Practice location:
  • Phone: 773-629-8217
  • Fax: 773-840-3182
Mailing address:
  • Phone: 630-581-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MILAP SHAH
Title or Position: OWNER
Credential:
Phone: 219-802-8800