Healthcare Provider Details

I. General information

NPI: 1992016414
Provider Name (Legal Business Name): CHICAGO PAIN & ORTHOPEDIC INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 08/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 W ERIE ST
CHICAGO IL
60654-5704
US

IV. Provider business mailing address

467 W ERIE ST
CHICAGO IL
60654-5704
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-9913
  • Fax:
Mailing address:
  • Phone: 312-337-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number038008101
License Number StateIL

VIII. Authorized Official

Name: JOSHUA HEDMAN
Title or Position: OWNER
Credential: M.D. DPM
Phone: 312-943-7246