Healthcare Provider Details

I. General information

NPI: 1295883668
Provider Name (Legal Business Name): MDC PHYSICIANS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 N HARLEM AVE
ELMWOOD PARK IL
60707-2020
US

IV. Provider business mailing address

2502 N HARLEM AVE
ELMWOOD PARK IL
60707-2020
US

V. Phone/Fax

Practice location:
  • Phone: 708-452-1220
  • Fax:
Mailing address:
  • Phone: 630-290-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL BANUELOS
Title or Position: PRESIDENT
Credential: DC
Phone: 708-452-1220