MEDICARE: MIDWEST DIALYSIS CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194758862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST DIALYSIS CENTER, INC

Provider Business Mailing Address
First Line	:	335 MAHN CT
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-2155
Country	:	US
Telephone Number	:	414-762-2020
Fax Number	:	414-762-2024

Provider Business Practice Location Address
First Line	:	2000 E LAYTON AVE
Second Line	:	SUITE 200
City	:	MILWAUKEE
State	:	WI
Zip	:	53235-6053
Country	:	US
Telephone Number	:	414-744-4343
Fax Number	:	414-744-4399

Authorized Official
Title or Position	:	V.P. OPERATIONS
Name	:	MR. DAVID A KURZ
Credential	:
Telephone Number	:	414-762-2020

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	11/01/2011

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