MEDICARE: MIDWEST THERAPY PROVIDERS 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician

General Provider Information

NPI Number	:	1578411666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST THERAPY PROVIDERS LLC

Provider Business Mailing Address
First Line	:	746 N LA SALLE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-3200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	746 N LA SALLE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-3200
Country	:	US
Telephone Number	:	312-951-8200
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARC STRONGIN
Credential	:
Telephone Number	:	312-951-8200

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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