MEDICARE: DR. DEBORAH ELIZABETH MIDGLEY M.D.

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	207Q00000X	Family Medicine Physician	036103248	IL

General Provider Information

NPI Number	:	1689780769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH ELIZABETH MIDGLEY M.D.

Provider Business Mailing Address
First Line	:	2750 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5247
Country	:	US
Telephone Number	:	312-666-3494
Fax Number	:	773-276-0749

Provider Business Practice Location Address
First Line	:	2750 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5247
Country	:	US
Telephone Number	:	312-666-3494
Fax Number	:	773-276-0749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/10/2021

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