Midwest Diagnostic Management, LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

MIDWEST DIAGNOSTIC MANAGEMENT, LLC

Practice address

19065 Hickory Creek PL
Suite 240
Mokena, IL 60448-8507

Phone

(708) 478-6417

Fax

(708) 535-8087

NPI assigned

Mar 24, 2007

Last updated

Dec 10, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jon Knipper

Title

Chief Operating Officer

Phone

(708) 478-6434

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228867200000",
    "number": "1003933920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19065 HICKORY CREEK PL",
            "address_2": "SUITE 240",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488507",
            "telephone_number": "708-478-6417",
            "fax_number": "708-535-8087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19065 HICKORY CREEK PL",
            "address_2": "SUITE 240",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488507",
            "telephone_number": "708-478-6417",
            "fax_number": "708-535-8087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST DIAGNOSTIC MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-24",
        "last_updated": "2008-12-10",
        "status": "A",
        "authorized_official_last_name": "KNIPPER",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "708-478-6434",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Mokena, IL
• Providers in Mokena, IL by specialty
• Exclusive Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.