=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881053791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDWEST CARE COORDINATOR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2016
-----------------------------------------------------
Last Update Date | 07/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 S MAIN ST SUITE 301
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-613-9185
-----------------------------------------------------
Fax | 630-519-4457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 S MAIN ST SUITE 301
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-613-9185
-----------------------------------------------------
Fax | 630-519-4457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SYED MOHAMMED MONIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-220-4022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335V00000X
-----------------------------------------------------
Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------