Healthcare Provider Details

I. General information

NPI: 1194734483
Provider Name (Legal Business Name): MIDWEST MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E DOUGLAS RD SUITE 208
MISHAWAKA IN
46545-1464
US

IV. Provider business mailing address

611 E DOUGLAS RD SUITE 208
MISHAWAKA IN
46545-1464
US

V. Phone/Fax

Practice location:
  • Phone: 574-232-5928
  • Fax: 574-232-4888
Mailing address:
  • Phone: 574-232-5928
  • Fax: 574-232-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM S. SARNAT
Title or Position: PRESIDENT
Credential: MD
Phone: 574-232-5928