Healthcare Provider Details

I. General information

NPI: 1376131391
Provider Name (Legal Business Name): CHICAGO SPINE AND VASCULAR INSTITUTE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 45TH ST STE 3
MUNSTER IN
46321-3962
US

IV. Provider business mailing address

PO BOX 3120
MUNSTER IN
46321-0120
US

V. Phone/Fax

Practice location:
  • Phone: 219-220-2021
  • 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: SHEEL PATEL
Title or Position: OWNER
Credential:
Phone: 304-615-8102