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General NPI Number Information
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NPI Number | 1003135526
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Entity Type | Organization
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Legal Business Name | WESTERN REHABILITATION AND PAIN MANAGEMENT, S.C.
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 2340 S HIGHLAND AVE SUITE 370
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City | LOMBARD
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State | IL
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Zip | 60148-5397
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Country | US
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Telephone | 630-873-5425
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Fax | 630-620-1196
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Provider Business Mailing Address
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Address Line | PO BOX 5978
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City | VILLA PARK
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State | IL
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Zip | 60181-5312
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Country | US
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Telephone | 630-873-5425
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Fax | 630-620-1196
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMED N SIDDIQUI
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Credential | D.O.
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Telephone | 630-873-5425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036082891
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License Number State | IL
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