Healthcare Provider Details

I. General information

NPI: 1134093214
Provider Name (Legal Business Name): REGENERATIVE PAIN & SPINE OF INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 BROADWAY
MERRILLVILLE IN
46410-4731
US

IV. Provider business mailing address

7725 BROADWAY
MERRILLVILLE IN
46410-4731
US

V. Phone/Fax

Practice location:
  • Phone: 312-300-3882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: SHOEB MOHIUDDIN
Title or Position: OWNER
Credential: MD
Phone: 312-300-3882