Provider Demographics
NPI:1487239067
Name:MIDWEST INNOVATIVE PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:MIDWEST INNOVATIVE PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FATTOUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-455-1153
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-0031
Mailing Address - Country:US
Mailing Address - Phone:219-440-0135
Mailing Address - Fax:833-523-9918
Practice Address - Street 1:2003 ARROWHEAD DR APT 3B
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-4952
Practice Address - Country:US
Practice Address - Phone:414-455-1153
Practice Address - Fax:833-523-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty