=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194885970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDWEST HEALTHPLUS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2929 S EILLS AVE 4 KAPLAN
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-791-2181
-----------------------------------------------------
Fax | 312-791-2508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7348 WINTHROP WAY UNIT 5
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60516-4080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-917-2181
-----------------------------------------------------
Fax | 312-791-2508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SEDO TAMAKLOE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 312-791-2181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------