Provider Demographics
NPI:1851459291
Name:MIDWEST PAIN MANAGEMENT ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:MIDWEST PAIN MANAGEMENT ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-569-1432
Mailing Address - Street 1:180 W PARK AVE
Mailing Address - Street 2:STE 260
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3357
Mailing Address - Country:US
Mailing Address - Phone:708-569-1432
Mailing Address - Fax:844-273-7876
Practice Address - Street 1:180 W PARK AVE
Practice Address - Street 2:STE 260
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3357
Practice Address - Country:US
Practice Address - Phone:708-569-1432
Practice Address - Fax:844-273-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070333207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL342740Medicare UPIN
IL342740Medicare ID - Type UnspecifiedMEDICARE