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General NPI Number Information
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NPI Number | 1538775770
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Entity Type | Organization
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Legal Business Name | REGENERATIVE PAIN & SPINE PLLC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 11536 S. WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone | 708-691-8841
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Fax | 708-452-1444
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Provider Business Mailing Address
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Address Line | PO BOX 719062
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City | CHICAGO
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State | IL
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Zip | 60677-9286
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Country | US
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Telephone | 312-300-3882
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Fax | 708-452-1444
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHOEB MOHIUDDIN
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Credential | MD
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Telephone | 708-691-8841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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