# MIDWAY MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861964959
- **Authorized official:** MARVIN COK (STAFF)
- **Authorized official phone:** (773) 597-7698

## Contact information

- **Practice address:** 2 W 103RD ST, CHICAGO, IL 60628-2619
- **Practice address phone:** (773) 597-7698
- **Mailing address:** 2 W 103RD ST, CHICAGO, IL 60628-2619
- **Mailing address phone:** (773) 597-7698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QM2800X | Methadone Clinic | — | NULL | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 12/30/2018
- **Last updated:** 07/22/2021