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General NPI Number Information
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NPI Number | 1801106851
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Entity Type | Organization
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Legal Business Name | MIDWEST MEDIX SURGERY CENTER
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 8630 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60652-3633
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Country | US
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Telephone | 773-767-8132
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Fax |
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Provider Business Mailing Address
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Address Line | 104 CIRCLE RIDGE DR
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City | BURR RIDGE
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State | IL
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Zip | 60527-8379
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Country | US
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Telephone | 630-632-4435
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABDUL R WAHOOD
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Credential | MD
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Telephone | 630-632-4435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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