Midwest Physician Group LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MIDWEST PHYSICIAN GROUP LTD

Doing business as

MIDWEST PHYSICIAN CENTER OF CRESTWOOD

Practice address

13811 Cicero Ave
Crestwood, IL 60445-1826

Phone

(708) 597-4477

Fax

(708) 597-4502

NPI assigned

Jan 31, 2007

Organization subpart

Yes

Parent organization

MIDWEST PHYSICIAN GROUP LTDAs reported in NPPES

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

Authorized official

Name

Deborah J Nelson

Title

Ceo

Phone

(708) 747-7960

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MIDWEST PHYSICIAN CENTER OF CRESTWOOD Doing business as

Part of

Par Family Med Ctr

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198195200000",
    "number": "1215074026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20110 GOVERNORS HWY",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611030",
            "telephone_number": "708-747-7960",
            "fax_number": "708-503-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13811 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604451826",
            "telephone_number": "708-597-4477",
            "fax_number": "708-597-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST PHYSICIAN GROUP LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDWEST PHYSICIAN GROUP LTD",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-12-21",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-747-7960"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0001616617",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIDWEST PHYSICIAN CENTER OF CRESTWOOD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Crestwood, IL
• Providers in Crestwood, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; 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.