Provider Demographics
NPI:1104294784
Name:PAIN AND WELLNESS SPECIALISTS SC
Entity type:Organization
Organization Name:PAIN AND WELLNESS SPECIALISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-821-8680
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-0003
Mailing Address - Country:US
Mailing Address - Phone:847-943-9457
Mailing Address - Fax:
Practice Address - Street 1:535 S ELM ST
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2187
Practice Address - Country:US
Practice Address - Phone:630-773-9416
Practice Address - Fax:630-397-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-12
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100250034Medicare PIN