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General NPI Number Information
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NPI Number | 1265565444
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Entity Type | Organization
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Legal Business Name | MIDWEST HYPERBARIC INSTITUTE, P.C.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 391 QUADRANGLE DR SUITE S-1
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3442
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Country | US
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Telephone | 630-378-1760
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Fax | 630-378-1764
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Provider Business Mailing Address
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Address Line | 391 QUADRANGLE DR SUITE S-1
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3442
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Country | US
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Telephone | 630-378-1760
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Fax | 630-378-1764
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AUGUST MARTINUCCI
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Credential | M.D.
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Telephone | 630-378-1760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 060.008568
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License Number State | IL
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