Provider Demographics
NPI:1922145804
Name:MIDWEST PHYSICAN PAIN CENTER
Entity Type:Organization
Organization Name:MIDWEST PHYSICAN PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANJIT
Authorized Official - Middle Name:S
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
Mailing Address - Country:US
Mailing Address - Phone:630-887-1483
Mailing Address - Fax:630-887-1483
Practice Address - Street 1:3522 E 95TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-933-0791
Practice Address - Fax:773-933-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
63915Medicare UPIN
935341Medicare ID - Type Unspecified