Healthcare Provider Details

I. General information

NPI: 1790743417
Provider Name (Legal Business Name): MIDWEST PULMONARY ASSOCIATES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 S HIGHLAND AVE 230
LOMBARD IL
60148-5371
US

IV. Provider business mailing address

2340 S HIGHLAND AVE 230
LOMBARD IL
60148-5371
US

V. Phone/Fax

Practice location:
  • Phone: 630-932-2040
  • Fax: 866-932-1513
Mailing address:
  • Phone: 630-932-2040
  • Fax: 866-932-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RONG S TU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-932-2040