Provider Demographics
NPI:1972344869
Name:MIDWEST EXPRESS CARE 2, INC
Entity type:Organization
Organization Name:MIDWEST EXPRESS CARE 2, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-802-8800
Mailing Address - Street 1:9900 RIDGELAND AVE UNIT 510
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1241
Mailing Address - Country:US
Mailing Address - Phone:708-312-1399
Mailing Address - Fax:708-515-4723
Practice Address - Street 1:9900 RIDGELAND AVE UNIT 510
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1241
Practice Address - Country:US
Practice Address - Phone:708-312-1399
Practice Address - Fax:708-515-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care