=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750507596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDWEST WOMEN'S SPECIALTY GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4414 S 7TH ST SUITE A
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-242-2229
-----------------------------------------------------
Fax | 812-242-2228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4414 S 7TH ST SUITE A
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-242-2229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. ALLAN Y WU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 812-242-2229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 01057730
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------