Healthcare Provider Details

I. General information

NPI: 1629502810
Provider Name (Legal Business Name): MIDWEST EXPRESS CARE 4 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SIBLEY ST STE A
HAMMOND IN
46320-1725
US

IV. Provider business mailing address

31 SIBLEY ST STE A
HAMMOND IN
46320-1725
US

V. Phone/Fax

Practice location:
  • Phone: 708-631-2781
  • Fax: 708-631-2783
Mailing address:
  • Phone: 708-631-2781
  • Fax: 708-631-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MILAP SHAH
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 708-631-2781