Healthcare Provider Details

I. General information

NPI: 1306636790
Provider Name (Legal Business Name): MIDWEST VASCULAR AND PAIN SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 S MANNHEIM RD
WESTCHESTER IL
60154-2515
US

IV. Provider business mailing address

943 S MANNHEIM RD
WESTCHESTER IL
60154-2515
US

V. Phone/Fax

Practice location:
  • Phone: 708-550-7005
  • Fax:
Mailing address:
  • Phone: 847-750-6877
  • Fax: 708-316-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE ISDALE
Title or Position: MANAGER
Credential:
Phone: 847-750-6877