Healthcare Provider Details

I. General information

NPI: 1265090872
Provider Name (Legal Business Name): MIDWEST ANESTHESIA AND PAIN SPECIALISTS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 ROSE ST
FRANKLIN PARK IL
60131-2068
US

IV. Provider business mailing address

9680 GOLF RD
DES PLAINES IL
60016-1522
US

V. Phone/Fax

Practice location:
  • Phone: 847-671-0555
  • Fax:
Mailing address:
  • Phone: 773-482-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA MALDONADO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 773-362-2917