Healthcare Provider Details

I. General information

NPI: 1437196623
Provider Name (Legal Business Name): MIDWEST EMERGENCY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARRINGTON RD ST ALEXIUS MEDICAL CENTER
HOFFMAN ESTATES IL
60194
US

IV. Provider business mailing address

PO BOX 637542
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-2000
  • Fax: 630-734-1560
Mailing address:
  • Phone: 865-292-3000
  • Fax: 865-470-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN HOLTZCLAW
Title or Position: PRESIDENT
Credential: MD
Phone: 440-887-4718