=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750525879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. NIHIR WAGHELA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2009
-----------------------------------------------------
Last Update Date | 06/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 OGDEN AVE RUSH-COPLEY MEDICAL CENTER
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-838-7641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1212 S MICHIGAN AVE APT 1503
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60605-2454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-838-7641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 036132172
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------