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General NPI Number Information
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NPI Number | 1487179495
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Entity Type | Organization
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Legal Business Name | MIDWEST REPRODUCTIVE CARE LLC
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 08/10/2017
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Provider Practice Location Address
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Address Line | 900 MAIN ST STE 330
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City | PEORIA
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State | IL
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Zip | 61602-5009
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Country | US
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Telephone | 877-373-7552
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Fax |
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Provider Business Mailing Address
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Address Line | 2252 TENNYSON LN
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-1640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TODD DEUTCH
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Credential | MD
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Telephone | 773-720-9958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 036.111547
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License Number State | IL
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