MEDICARE: MIDWAY SPINE AND JOINT PAIN PHYSICIANS

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
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1689226318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWAY SPINE AND JOINT PAIN PHYSICIANS

Provider Business Mailing Address
First Line	:	5720 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5720 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4435
Country	:	US
Telephone Number	:	708-788-7246
Fax Number	:	708-788-7247

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NATALYA SMIRNOVA
Credential	:
Telephone Number	:	708-788-7246

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	07/12/2019

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Directions to “MIDWAY SPINE AND JOINT PAIN PHYSICIANS ” Practice Location

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