# MIDWEST PHYSICIAN GROUP LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MIDWEST PHYSICIAN CENTER OF BOURBONNAIS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073650818
- **Authorized official:** DEBORAH J NELSON (CEO)
- **Authorized official phone:** (708) 747-7960

## Contact information

- **Practice address:** 595 WILLIAM R LATHAM SR DR, BOURBONNAIS, IL 60914-2319
- **Practice address phone:** (815) 932-8944
- **Practice address fax:** (815) 932-9159
- **Mailing address:** 20110 GOVERNORS HWY, OLYMPIA FIELDS, IL 60461-1030
- **Mailing address phone:** (708) 747-7960
- **Mailing address fax:** (708) 503-3993

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | — |
| 207K00000X | Allergy & Immunology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207RR0500X | Rheumatology Physician | — | NULL | Yes |
| 207RR0500X | Rheumatology Physician | — | — | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 01/31/2007
- **Last updated:** 09/11/2025