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General NPI Number Information
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NPI Number | 1356404149
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Entity Type | Organization
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Legal Business Name | MIDWEST PAIN & ANESTHESIOLOGY
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 845 N MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60611-2252
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Country | US
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Telephone | 312-944-2929
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Fax | 312-867-7895
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Provider Business Mailing Address
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Address Line | 907 WASHINGTON ST
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-3517
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Country | US
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Telephone | 219-872-9158
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Fax | 219-873-9196
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL C MADISON
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Credential | M.D.
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Telephone | 312-944-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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