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General NPI Number Information
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NPI Number | 1740154947
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Entity Type | Organization
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Legal Business Name | MIDWEST SPORTS AND INTERVENTIONAL SPINE SC
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 850 GENEVA PKWY N STE 100
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City | LAKE GENEVA
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State | WI
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Zip | 53147-4562
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Country | US
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Telephone | 262-299-6199
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Fax | 262-293-6953
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Provider Business Mailing Address
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Address Line | 2070 GREEN BAY RD STE 163
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2412
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Country | US
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Telephone | 262-299-6199
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Fax | 262-293-6953
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Authorized Official
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Title or Position | OWNER
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Name | CYRIL N PHILIP
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Credential | MD
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Telephone | 847-343-0711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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