| Sa Midtown Clinic | |
|
1340 Charles St Suite 405 Rockford IL 61104 | |
| (779) 696-5353 | |
| Not Available |
| Full Name | Sa Midtown Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1340 Charles St, Rockford, Illinois |
| Authorized Official Name and Position | Don Daniels (VP) |
| Authorized Official Contact | 8159662084 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sa Midtown Clinic Po Box 78866 Milwaukee WI 53278-8866 Ph: () - | Sa Midtown Clinic 1340 Charles St Suite 405 Rockford IL 61104 Ph: (779) 696-5353 |
| NPI Number | 1619029881 |
|---|---|
| Provider Enumeration Date | 01/17/2007 |
| Last Update Date | 07/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619029881 | NPI | - | NPPES |
| 14D0430105 | Other | IL | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
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