Provider Demographics
NPI:1437542651
Name:MIDWEST ANESTHESIA AND PAIN SPECIALISTS, SC
Entity Type:Organization
Organization Name:MIDWEST ANESTHESIA AND PAIN SPECIALISTS, SC
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:MD
Authorized Official - Phone:773-362-2917
Mailing Address - Street 1:9680 GOLF ROAD
Mailing Address - Street 2:
Mailing Address - City:DESPLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016
Mailing Address - Country:US
Mailing Address - Phone:773-362-2917
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:773-362-2917
Practice Address - Fax:773-362-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-60016-01Medicaid
ILF100149755Medicare PIN