Healthcare Provider Details

I. General information

NPI: 1225853450
Provider Name (Legal Business Name): MIDWEST EXPRESS CARE 2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROOSEVELT RD
LOMBARD IL
60148-4740
US

IV. Provider business mailing address

PO BOX 775253
CHICAGO IL
60677-5253
US

V. Phone/Fax

Practice location:
  • Phone: 630-206-5574
  • Fax: 630-214-9578
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MILAP SHAH
Title or Position: AO
Credential:
Phone: 219-802-8800