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General NPI Number Information
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NPI Number | 1851459291
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Entity Type | Organization
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Legal Business Name | MIDWEST PAIN MANAGEMENT ASSOCIATES, LTD.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 180 W PARK AVE STE 260
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City | ELMHURST
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State | IL
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Zip | 60126-3357
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Country | US
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Telephone | 708-569-1432
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Fax | 844-273-7876
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Provider Business Mailing Address
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Address Line | 180 W PARK AVE STE 260
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City | ELMHURST
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State | IL
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Zip | 60126-3357
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Country | US
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Telephone | 708-569-1432
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Fax | 844-273-7876
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN V. O'HARA
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Credential | MD
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Telephone | 708-569-1432
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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 | 036070333
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License Number State | IL
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