Healthcare Provider Details

I. General information

NPI: 1871545681
Provider Name (Legal Business Name): MIDWEST RETINA CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W. GOLF ROAD 206
DES PLAINES IL
60016
US

IV. Provider business mailing address

8901 W. GOLF ROAD 206
DES PLAINES IL
60016-6850
US

V. Phone/Fax

Practice location:
  • Phone: 847-699-0006
  • Fax: 847-699-1744
Mailing address:
  • Phone: 847-699-0006
  • Fax: 847-699-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE JURIC WYHINNY
Title or Position: PRESIDENT
Credential: MD
Phone: 847-699-0006