Healthcare Provider Details

I. General information

NPI: 1417129594
Provider Name (Legal Business Name): MIDWEST HEALTH WORKS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 PLAINFIELD RD STE B
WILLOWBROOK IL
60527-7601
US

IV. Provider business mailing address

545 PLAINFIELD RD STE B
WILLOWBROOK IL
60527-7601
US

V. Phone/Fax

Practice location:
  • Phone: 630-286-5300
  • Fax:
Mailing address:
  • Phone: 630-286-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JAMES T JOHN
Title or Position: PRESIDENT
Credential:
Phone: 630-286-5300