Basic Information
| Provider Information | |||||||||
| NPI: | 1922749563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST INTERVENTIONAL PAIN SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 734968 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606734968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10258 SOUTHWEST HWY STE B | ||||||||
| Address2: | |||||||||
| City: | CHICAGO RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604151361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2022 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | DONKOH | ||||||||
| AuthorizedOfficialFirstName: | YAW | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9175497115 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MIDWEST INTERVENTIONAL PAIN SOLUTIONS LLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.