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Organization
MIDWEST PHYSICIAN GROUP LTD
Active
Organization
MIDWEST PHYSICIAN GROUP LTD
Active
Other names
MIDWEST PHYSICIAN CENTER OF BRIDGEPORT
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH J NELSON (CEO)
(708) 747-7960
Entity
Organization
Contact information
Practice address
3201 S WALLACE ST, CHICAGO, IL 60616-3501
(312) 326-1615
(312) 326-3910
Mailing address
20110 GOVERNORS HWY, OLYMPIA FIELDS, IL 60461-1030
(708) 747-7960
(708) 503-3993
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001616617
BCBS
IL
Enumeration date
01/31/2007
Last updated
08/22/2020
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