Provider Demographics
NPI:1194100511
Name:MIDWEST SURGICAL PROFESSIONALS LLC
Entity type:Organization
Organization Name:MIDWEST SURGICAL PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-988-3223
Mailing Address - Street 1:19275 W CAPITOL DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2742
Mailing Address - Country:US
Mailing Address - Phone:262-701-7040
Mailing Address - Fax:262-701-4978
Practice Address - Street 1:19275 W CAPITOL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2742
Practice Address - Country:US
Practice Address - Phone:262-701-7040
Practice Address - Fax:262-701-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61806-20207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK100235160Medicare PIN