Provider Demographics
NPI:1538775770
Name:REGENERATIVE PAIN & SPINE PLLC
Entity type:Organization
Organization Name:REGENERATIVE PAIN & SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOEB
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-691-8841
Mailing Address - Street 1:1658 N MILWAUKEE AVE # 295
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6905
Mailing Address - Country:US
Mailing Address - Phone:312-300-3882
Mailing Address - Fax:708-452-1444
Practice Address - Street 1:2122 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3581
Practice Address - Country:US
Practice Address - Phone:708-691-8841
Practice Address - Fax:708-452-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty