Healthcare Provider Details

I. General information

NPI: 1871522631
Provider Name (Legal Business Name): MIDWEST PHYSICAN PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 E 95TH ST
CHICAGO IL
60617-5164
US

IV. Provider business mailing address

8 CASCADE CT W
BURR RIDGE IL
60527-0715
US

V. Phone/Fax

Practice location:
  • Phone: 630-202-2230
  • Fax: 773-933-4903
Mailing address:
  • Phone: 630-887-1482
  • Fax: 773-933-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RANJIT SINGH WAHI
Title or Position: OWNER
Credential: MD
Phone: 773-933-0791