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General NPI Number Information
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NPI Number | 1811792419
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Entity Type | Organization
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Legal Business Name | MIDWEST MEDICAL INSTITUTE S.C.
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 5251 CRESTDALE DR
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City | ROCKFORD
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State | IL
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Zip | 61114-6413
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Country | US
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Telephone | 815-209-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 5251 CRESTDALE DR
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City | ROCKFORD
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State | IL
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Zip | 61114-6413
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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 | VASIL NIKA
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Credential |
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Telephone | 815-209-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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