Provider Demographics
NPI:1992016414
Name:CHICAGO PAIN & ORTHOPEDIC INSTITUTE
Entity Type:Organization
Organization Name:CHICAGO PAIN & ORTHOPEDIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD DPM
Authorized Official - Phone:312-943-7246
Mailing Address - Street 1:467 W ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5704
Mailing Address - Country:US
Mailing Address - Phone:312-337-9913
Mailing Address - Fax:
Practice Address - Street 1:467 W ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5704
Practice Address - Country:US
Practice Address - Phone:312-337-9913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008101204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty