Provider Demographics
NPI:1922749563
Name:MIDWEST INTERVENTIONAL PAIN SOLUTIONS LLC
Entity Type:Organization
Organization Name:MIDWEST INTERVENTIONAL PAIN SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAW
Authorized Official - Middle Name:N
Authorized Official - Last Name:DONKOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-549-7115
Mailing Address - Street 1:PO BOX 734968
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-4968
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:
Practice Address - Street 1:10258 SOUTHWEST HWY STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1361
Practice Address - Country:US
Practice Address - Phone:800-444-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST INTERVENTIONAL PAIN SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain