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General NPI Number Information
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NPI Number | 1295751956
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Entity Type | Organization
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Legal Business Name | MIDWEST MA, LLC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4650 SOUTHWEST HWY
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City | OAK LAWN
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State | IL
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Zip | 60453-1836
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Country | US
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Telephone | 708-424-3201
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 LAKE COOK ROAD SUITE M
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City | DEERFIELD
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State | IL
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Zip | 60015-5234
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Country | US
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Telephone | 847-945-4550
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Fax | 847-948-8103
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | HOWARD S KONOWITZ
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Credential | MD
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Telephone | 847-921-9733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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