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General NPI Number Information
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NPI Number | 1356074264
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Entity Type | Organization
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Legal Business Name | MIDWEST PRIMARY CARE AND GERIATRICS LLC
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Dates
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Enumeration Date | 07/07/2022
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 1440 MAPLE AVE STE 4A
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City | LISLE
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State | IL
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Zip | 60532-4135
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Country | US
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Telephone | 708-420-3169
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 MAPLE AVE STE 4A
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City | LISLE
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State | IL
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Zip | 60532-4135
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Country | US
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Telephone | 708-420-3169
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NAUSHEEN AHMED
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Credential |
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Telephone | 708-420-3169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 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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