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General NPI Number Information
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NPI Number | 1477673275
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Entity Type | Individual
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Provider Name | DAVID GEORGE MIDLICK C.C.T,BA
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6686 DOUBLE EAGLE DR UNIT 103
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City | WOODRIDGE
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State | IL
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Zip | 60517-5428
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Country | US
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Telephone | 630-663-9811
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Fax | 630-663-9018
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Provider Business Mailing Address
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Address Line | 6686 DOUBLE EAGLE DR UNIT 103
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City | WOODRIDGE
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State | IL
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Zip | 60517-5428
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Country | US
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Telephone | 630-663-9811
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Fax | 630-663-9018
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C1101X
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Taxonomy Name | Cardiovascular-Interventional Technology Radiologic Technologist
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License Number |
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License Number State |
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