MEDICARE: MIDS, 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	207R00000X	Internal Medicine Physician
2	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1366097016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDS, LLC

Provider Business Mailing Address
First Line	:	3838 N MAIN ST STE 1C
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-3100
Country	:	US
Telephone Number	:	574-404-3980
Fax Number	:	574-931-8601

Provider Business Practice Location Address
First Line	:	3838 N MAIN ST STE 1C
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-3100
Country	:	US
Telephone Number	:	574-404-3980
Fax Number	:	574-931-8601

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LLOYD SCHULMAN
Credential	:
Telephone Number	:	574-286-6802

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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Directions to “MIDS, LLC ” Practice Location

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