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General NPI Number Information
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NPI Number | 1801759980
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Entity Type | Organization
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Legal Business Name | MIDWEST WELLNESS HEALTHCARE
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 405 E CONGRESS PKWY STE C STE C
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6229
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Country | US
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Telephone | 847-530-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 405 E CONGRESS PKWY STE C
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6229
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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 | OWNER
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Name | RONALD MASUKAWA
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Credential |
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Telephone | 847-530-7310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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