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 Bridgeport

Practice address

3201 S Wallace St
Chicago, IL 60616-3501

Phone

(312) 326-1615

Fax

(312) 326-3910

NPI assigned

Jan 31, 2007

Last updated

Aug 22, 2020By 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

Deborah J Nelson

Title

Ceo

Phone

(708) 747-7960

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MIDWEST PHYSICIAN CENTER OF BRIDGEPORT Doing business as

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699812487",
    "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": "3201 S WALLACE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163501",
            "telephone_number": "312-326-1615",
            "fax_number": "312-326-3910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST PHYSICIAN GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-08-22",
        "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 BRIDGEPORT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Chicago, IL
• Providers in Chicago, 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 Aug 22, 2020; 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.