MEDICARE: MIDWEST URGENT MEDICAL SERVICES LLC

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	261QU0200X	Urgent Care 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	:	1215982491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST URGENT MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	4555 W SCHROEDER DR
Second Line	:	SUITE 170
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-1475
Country	:	US
Telephone Number	:	414-365-3210
Fax Number	:	414-365-3225

Provider Business Practice Location Address
First Line	:	2603 W RAWSON AVE
Second Line	:	SUITE 113
City	:	OAK CREEK
State	:	WI
Zip	:	53154-8422
Country	:	US
Telephone Number	:	414-431-6900
Fax Number	:	414-435-0016

Authorized Official
Title or Position	:	PARTNER/PHYSICIAN MD/DIRECTOR
Name	:	ARIF G JAKA
Credential	:	MD
Telephone Number	:	414-431-6900

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	04/24/2012

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