Organization Name: | MID AMERICA MEDICAL CENTER, LTD |
NPI Number: | 1407117468 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | IBRAHIM SADEK (MEDICAL DIRECTOR/OWNER) |
Mailing Address: | 639 W North Ave Villa Park |
State: | IL US |
Postal Code: | 601811321 |
Phone Number: | 6305160960 |
Fax Number: | 6305160951 |
NPI Enumeration Date: | 06/06/2012 |
NPI Last Update Date: | 06/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261Q00000X |
License Number: | 036-083248 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |