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Organization
MIDWEST PHYSICIAN GROUP LTD.
Active
Organization
MIDWEST PHYSICIAN GROUP LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEBORAH J NELSON (CHIEF EXECUTIVE OFFICER)
(708) 747-7960
Entity
Organization
Contact information
Practice address
20110 GOVERNORS HWY, SUITE 1, OLYMPIA FIELDS, IL 60461-1030
(708) 747-7960
(708) 503-3993
Mailing address
20110 GOVERNORS HWY, SUITE 1, OLYMPIA FIELDS, IL 60461-1030
(708) 747-7960
(708) 503-3993
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42005377
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001616617
BLUE SHIELD ID
IL
01
—
C10237
RAILROAD MEDICARE GROUP
IL
01
—
CA1946
RAILROAD MEDICARE GROUP
IL
01
—
CA7850
RAILROAD MEDICARE GROUP
IL
01
—
CC6202
RAILROAD MEDICARE GROUP
IL
01
—
CD4066
RAILROAD MEDICARE GROUP
IL
Enumeration date
05/18/2006
Last updated
12/10/2007
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