Provider Demographics
NPI:1871545681
Name:MIDWEST RETINA CONSULTANTS, S.C.
Entity type:Organization
Organization Name:MIDWEST RETINA CONSULTANTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JURIC
Authorized Official - Last Name:WYHINNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-699-0006
Mailing Address - Street 1:8901 W. GOLF ROAD
Mailing Address - Street 2:206
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6850
Mailing Address - Country:US
Mailing Address - Phone:847-699-0006
Mailing Address - Fax:847-699-1744
Practice Address - Street 1:8901 W. GOLF ROAD
Practice Address - Street 2:206
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-699-0006
Practice Address - Fax:847-699-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL431990Medicare ID - Type Unspecified