Healthcare Provider Details

I. General information

NPI: 1922145804
Provider Name (Legal Business Name): MIDWEST PHYSICAN PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 E 95TH STREET
CHICAGO IL
60617
US

IV. Provider business mailing address

8 CASCADE CT W
BURR RIDGE IL
60527
US

V. Phone/Fax

Practice location:
  • Phone: 773-933-0791
  • Fax: 773-933-4903
Mailing address:
  • Phone: 630-887-1483
  • Fax: 630-887-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RANJIT S WAHI
Title or Position: PRESIDENT
Credential: MD
Phone: 773-933-0791