Provider Demographics
NPI:1255709143
Name:MIDWEST MEDICAL PRACTITIONERS LLC
Entity type:Organization
Organization Name:MIDWEST MEDICAL PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:JABBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-282-0380
Mailing Address - Street 1:1153 E GANNON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2611
Mailing Address - Country:US
Mailing Address - Phone:636-282-0380
Mailing Address - Fax:877-592-0806
Practice Address - Street 1:1153 E GANNON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2611
Practice Address - Country:US
Practice Address - Phone:636-282-0380
Practice Address - Fax:877-592-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009017188OtherLICENSE NUMBER