Provider Demographics
NPI:1366947400
Name:MIDWEST PHYSICIANS GROUP
Entity type:Organization
Organization Name:MIDWEST PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-246-1690
Mailing Address - Street 1:PO BOX 69141
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63169-0141
Mailing Address - Country:US
Mailing Address - Phone:314-246-1690
Mailing Address - Fax:800-331-9716
Practice Address - Street 1:119 CHURCH ST STE 135
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2459
Practice Address - Country:US
Practice Address - Phone:314-246-1690
Practice Address - Fax:800-331-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty