Provider Demographics
NPI:1871522631
Name:MIDWEST PHYSICAN PAIN CENTER
Entity type:Organization
Organization Name:MIDWEST PHYSICAN PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANJIT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:WAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-933-0791
Mailing Address - Street 1:8 CASCADE CT W
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0715
Mailing Address - Country:US
Mailing Address - Phone:630-887-1482
Mailing Address - Fax:773-933-4903
Practice Address - Street 1:3522 E 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-5164
Practice Address - Country:US
Practice Address - Phone:630-202-2230
Practice Address - Fax:773-933-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076159Medicaid