Contract Details
Facility name
Midwest Diagnostic Management
Provider ID
P000002258
NPI
1003933920
Tax ID
364393918
Effective Date
3/15/2006
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_093
Location Details
Address
10965 Hickory Creek Place Suite 240
Mokena, IL 60448
United States
County
Will
Phone
7084786417 (Phone)
Billing Details
Address
10965 Hickory Creek Place
Suite 240
Mokena, IL 60448
Billing Phone
7084786417
Specialty Type
Diagnostic Services
Map
Address