Healthcare Provider Details

I. General information

NPI: 1154921294
Provider Name (Legal Business Name): MIDWEST EXPRESS CARE 4, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 US HIGHWAY 6 STE C
PORTAGE IN
46368-5058
US

IV. Provider business mailing address

PO BOX 775342
CHICAGO IL
60677-5342
US

V. Phone/Fax

Practice location:
  • Phone: 219-841-9788
  • Fax: 219-254-2364
Mailing address:
  • Phone: 219-841-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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