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Organization
MIDLAKE MEDICAL CORPORATION
Active
Organization
MIDLAKE MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REUBEN TERRANCE NICHOLS MD (PRESIDENT)
(312) 808-1600
Entity
Organization
Contact information
Practice address
2930 SOUTH MICHIGAN AVENUE, SUITE 101, CHICAGO, IL 60616-3484
(312) 808-1600
(312) 808-0985
Mailing address
2930 SOUTH MICHIGAN AVENUE, SUITE 101, CHICAGO, IL 60616-3484
(312) 808-1600
(312) 808-0985
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
02/13/2007
Last updated
08/22/2020
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