Basic Information
| Provider Information | |||||||||
| NPI: | 1912546722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST EXPRESS CARE 2, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 775253 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606775253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305835372 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2868 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606576017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735693525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2019 | ||||||||
| LastUpdateDate: | 12/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHAH | ||||||||
| AuthorizedOfficialFirstName: | MILAP | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6305815372 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MIDWEST EXPRESS CARE 2, INC | ||||||||
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| NPICertificationDate: | 12/26/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.