| Organization Name: | MIDWEST SPORTS MEDICINE |
| NPI Number: | 1063813517 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LETICIA PEDRAZA (CFO) |
| Mailing Address: | 901 Biesterfield Rd Ste 306 Elk Grove Village |
| State: | IL US |
| Postal Code: | 600077324 |
| Phone Number: | 8474371230 |
| Fax Number: | 8474379023 |
| NPI Enumeration Date: | 09/15/2014 |
| NPI Last Update Date: | 09/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 070.021091 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |