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General NPI Number Information
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NPI Number | 1275882235
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Entity Type | Organization
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Legal Business Name | MIDMED SERVICES, LLC
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 1736 ESSINGTON RD STE C
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City | JOLIET
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State | IL
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Zip | 60435-1602
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Country | US
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Telephone | 312-399-7185
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Fax |
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Provider Business Mailing Address
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Address Line | 19950 BERKSHIRE DR
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City | MOKENA
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State | IL
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Zip | 60448-1667
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Country | US
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Telephone | 312-399-7185
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY MIDDLETON
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Credential | M.D.
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Telephone | 312-399-7185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036103921
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License Number State | IL
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