Healthcare Provider Details

I. General information

NPI: 1407933831
Provider Name (Legal Business Name): MIDWEST RESPIRATORY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 129TH INFANTRY DR SUITE 400
JOLIET IL
60435-3171
US

IV. Provider business mailing address

903 129TH INFANTRY DR SUITE 400
JOLIET IL
60435-3171
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-2653
  • Fax: 815-744-3232
Mailing address:
  • Phone: 815-725-2653
  • Fax: 815-744-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number042-618083
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number042-618083
License Number StateIL

VIII. Authorized Official

Name: JOHN M WALSH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-725-2653