| Midwest Integrated Medical Center Llc | |
|
2920 Enloe St Ste 105 Hudson WI 54016-8191 | |
| (715) 808-0716 | |
| Not Available |
| Full Name | Midwest Integrated Medical Center Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2920 Enloe St Ste 105, Hudson, Wisconsin |
| Authorized Official Name and Position | Daryl Cooper (OWNER) |
| Authorized Official Contact | 7158080716 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Integrated Medical Center Llc 2920 Enloe St Ste 105 Hudson WI 54016-8191 Ph: (715) 808-0716 | Midwest Integrated Medical Center Llc 2920 Enloe St Ste 105 Hudson WI 54016-8191 Ph: (715) 808-0716 |
| NPI Number | 1770095796 |
|---|---|
| Provider Enumeration Date | 10/31/2017 |
| Last Update Date | 01/22/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770095796 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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