Active NPI
Midwest Physician Group LTD
- Cardiovascular Disease Physician
- Olympia Fields, IL
National Provider Identifier
1972640654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- Legal business name
- MIDWEST PHYSICIAN GROUP LTD
- Practice address
- 3800 W 203Rd St
Suite 202
Olympia Fields, IL 60461-1184 - Phone
- (708) 747-0461
- Fax
- (708) 747-4704
- NPI assigned
- Jan 31, 2007
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | Primary |
Addresses
Primary practice location
3800 W 203Rd St
Suite 202
Olympia Fields, IL 60461-1184
Mailing address
20110 Governors Hwy
Olympia Fields, IL 60461-1030
Phone (708) 747-7960
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001616617 | Other | IL | BCBS |
Other names 1
- MPC-CARDIOVASCULAR INSTITUTE
National Provider Directory
National Provider DirectoryNPI Registry JSON
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": "1972640654",
"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": "3800 W 203RD ST",
"address_2": "SUITE 202",
"city": "OLYMPIA FIELDS",
"state": "IL",
"postal_code": "604611184",
"telephone_number": "708-747-0461",
"fax_number": "708-747-4704"
}
],
"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": "207RC0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0001616617",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MPC-CARDIOVASCULAR INSTITUTE",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Olympia Fields, IL
Sources for this page
- 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.