| Midc, Llc | |
|
13657 W Mcdowell Rd Suite 118 Goodyear AZ 85395-2601 | |
| (623) 328-7794 | |
| (623) 328-7932 |
| Full Name | Midc, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 13657 W Mcdowell Rd, Goodyear, Arizona |
| Authorized Official Name and Position | Tara Kowalski (CREDENTIALING MANAGER) |
| Authorized Official Contact | 8882206432 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midc, Llc 901 Mcclintock Dr Suite 202 Burr Ridge IL 60527-0871 Ph: (888) 220-6432 | Midc, Llc 13657 W Mcdowell Rd Suite 118 Goodyear AZ 85395-2601 Ph: (623) 328-7794 |
| NPI Number | 1073854600 |
|---|---|
| Provider Enumeration Date | 03/06/2013 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 3072425784 |
|---|---|
| Medicare Enrollment ID | O20130607000212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073854600 | NPI | - | NPPES |
| 780223 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (Arizona) | Primary |
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