Provider Demographics
NPI:1366097016
Name:MIDS, LLC
Entity type:Organization
Organization Name:MIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-286-6802
Mailing Address - Street 1:3838 N MAIN ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3100
Mailing Address - Country:US
Mailing Address - Phone:574-404-3980
Mailing Address - Fax:574-931-8601
Practice Address - Street 1:3838 N MAIN ST STE 1C
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3100
Practice Address - Country:US
Practice Address - Phone:574-404-3980
Practice Address - Fax:574-931-8601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty