The suburb is located on flat land at the southern end of the Otahuhu Isthmus, at the end of an arm of the Tamaki River. It is 18 kilometres southeast of Auckland city centre. It is located on State Highway 1 and the North Island Main Trunk Railway passes by the Middlemore Hospital.
Middlemore's most well-known landmarks are Middlemore Hospital and the Auckland Golf Club course, which surrounds the hospital grounds. Adjacent to both the golf club and Otahuhu College is the private secondary school, King's College.
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