MEDICARE: MIDWEST EXPRESS CARE 2, 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1982298469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST EXPRESS CARE 2, INC

Provider Business Mailing Address
First Line	:	PO BOX 775253
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12850 S ASHLAND AVE
Second Line	:
City	:	CALUMET PARK
State	:	IL
Zip	:	60827-6308
Country	:	US
Telephone Number	:	708-972-7958
Fax Number	:	708-972-7969

Authorized Official
Title or Position	:	OWNER
Name	:	MILAP SHAH
Credential	:
Telephone Number	:	219-802-8800

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	02/24/2021

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