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NPI Code Detail

MEDICARE: MIDWEST PAIN AND SPINE PHYSICIANS LLC

MEDICARE: MIDWEST PAIN AND SPINE PHYSICIANS LLC
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
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1962979278
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST PAIN AND SPINE PHYSICIANS LLC
Provider Business Mailing Address
First Line : 4354 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-5039
Country : US
Telephone Number : 773-482-5800
Fax Number : 773-362-2768
Provider Business Practice Location Address
First Line : 4354 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-5039
Country : US
Telephone Number : 773-482-5800
Fax Number : 773-362-2917
Authorized Official
Title or Position : CEO
Name : DARREL J. SALDANHA
Credential :
Telephone Number : 773-482-5800
Provider Enumeration Date : 10/25/2018
Last Update Date : 10/25/2018

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Directions to “MIDWEST PAIN AND SPINE PHYSICIANS LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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