Healthcare Provider Details

I. General information

NPI: 1538775770
Provider Name (Legal Business Name): REGENERATIVE PAIN & SPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11536 S. WESTERN AVE
CHICAGO IL
60643
US

IV. Provider business mailing address

PO BOX 719062
CHICAGO IL
60677-9286
US

V. Phone/Fax

Practice location:
  • Phone: 708-691-8841
  • Fax: 708-452-1444
Mailing address:
  • Phone: 312-300-3882
  • Fax: 708-452-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHOEB MOHIUDDIN
Title or Position: OWNER
Credential: MD
Phone: 708-691-8841