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Organization
MIDWAY MEDICAL
Active
Organization
MIDWAY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN COK (STAFF)
(773) 597-7698
Entity
Organization
Contact information
Practice address
2 W 103RD ST, CHICAGO, IL 60628-2619
(773) 597-7698
Mailing address
2 W 103RD ST, CHICAGO, IL 60628-2619
(773) 597-7698
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
261QM2800X
Methadone Clinic
—
NULL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
Other
Enumeration date
12/30/2018
Last updated
07/22/2021
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