Organization
MIDWEST PHYSICIAN GROUP LTD
Active
Other names
MIDWEST PHYSICIAN CENTER OF BOURBONNAIS
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH J NELSON (CEO)
(708) 747-7960
Entity
Organization
Contact information
Practice address
595 WILLIAM R LATHAM SR DR, BOURBONNAIS, IL 60914-2319
(815) 932-8944
(815) 932-9159
Mailing address
20110 GOVERNORS HWY, OLYMPIA FIELDS, IL 60461-1030
(708) 747-7960
(708) 503-3993
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207RR0500X
Rheumatology Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001616617
BCBS
IL
Enumeration date
01/31/2007
Last updated
09/11/2025
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