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NPI Code Detail

MEDICARE: WINDY CITY PAIN RELIEF, S.C.

MEDICARE: WINDY CITY PAIN RELIEF, S.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1023586617
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINDY CITY PAIN RELIEF, S.C.
Provider Business Mailing Address
First Line : PO BOX 16008
Second Line :
City : CHICAGO
State : IL
Zip : 60616-0001
Country : US
Telephone Number : 708-972-9695
Fax Number : 708-576-8491
Provider Business Practice Location Address
First Line : 5571 W 95TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-2356
Country : US
Telephone Number : 708-972-9695
Fax Number : 708-401-0194
Authorized Official
Title or Position : PROVIDER, SHAREHOLDER
Name : DR. SHANELE NICHOLE MCGOWAN
Credential : MD
Telephone Number : 312-560-8061
Provider Enumeration Date : 11/13/2018
Last Update Date : 12/27/2019

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Directions to “WINDY CITY PAIN RELIEF, S.C. ” Practice Location

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