Healthcare Provider Details

I. General information

NPI: 1447899422
Provider Name (Legal Business Name): MIDWEST EXPRESS CARE 2, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N DAMEN AVE
CHICAGO IL
60622-1967
US

IV. Provider business mailing address

PO BOX 775253
CHICAGO IL
60677-5253
US

V. Phone/Fax

Practice location:
  • Phone: 312-283-5560
  • Fax:
Mailing address:
  • Phone: 630-583-5372
  • 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