Provider Demographics
NPI:1962979278
Name:MIDWEST PAIN AND SPINE PHYSICIANS LLC
Entity type:Organization
Organization Name:MIDWEST PAIN AND SPINE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALDANHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-482-5800
Mailing Address - Street 1:4354 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5039
Mailing Address - Country:US
Mailing Address - Phone:773-482-5800
Mailing Address - Fax:773-362-2768
Practice Address - Street 1:4354 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5039
Practice Address - Country:US
Practice Address - Phone:773-482-5800
Practice Address - Fax:773-362-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty