Provider Demographics
NPI:1083669477
Name:MIDWEST ACADEMY OF PAIN & SPINE INC
Entity Type:Organization
Organization Name:MIDWEST ACADEMY OF PAIN & SPINE INC
Other - Org Name:MAPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NESREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-670-4111
Mailing Address - Street 1:2867 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1634
Mailing Address - Country:US
Mailing Address - Phone:630-420-8080
Mailing Address - Fax:630-778-9090
Practice Address - Street 1:2867 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1634
Practice Address - Country:US
Practice Address - Phone:630-420-8080
Practice Address - Fax:630-778-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095342Medicaid
IL0001635238OtherBCBS
IL211679Medicare ID - Type UnspecifiedCOOK
IL036095342Medicaid