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General NPI Number Information
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NPI Number | 1073650818
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Entity Type | Organization
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Legal Business Name | MIDWEST PHYSICIAN GROUP LTD
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 595 WILLIAM R LATHAM SR DR
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2319
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Country | US
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Telephone | 815-932-8944
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Fax | 815-932-9159
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Provider Business Mailing Address
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Address Line | 20110 GOVERNORS HWY
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1030
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Country | US
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Telephone | 708-747-7960
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Fax | 708-503-3993
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Authorized Official
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Title or Position | CEO
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Name | DEBORAH J NELSON
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Credential |
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Telephone | 708-747-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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