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General NPI Number Information
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NPI Number | 1588987937
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Entity Type | Organization
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Legal Business Name | MIDWEST PHYSICIAN NETWORK
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 326 W 64TH ST
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City | CHICAGO
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State | IL
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Zip | 60621-3114
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Country | US
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Telephone | 708-204-4385
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1328
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City | MATTESON
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State | IL
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Zip | 60443-4328
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Country | US
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Telephone | 708-204-4385
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | DR. RITA JUANITA MCGUIRE
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Credential | M.D.
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Telephone | 708-204-4385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 036090427
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License Number State | IL
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