Provider Demographics
NPI:1669414983
Name:MIDWEST SPORTS AND PAIN SPECIALISTS, P.C.
Entity type:Organization
Organization Name:MIDWEST SPORTS AND PAIN SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-378-4590
Mailing Address - Street 1:1999 SPRINGBROOK SQUARE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5946
Mailing Address - Country:US
Mailing Address - Phone:630-378-4590
Mailing Address - Fax:630-378-4592
Practice Address - Street 1:1999 SPRINGBROOK SQUARE DR
Practice Address - Street 2:STE 101
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5946
Practice Address - Country:US
Practice Address - Phone:630-378-4590
Practice Address - Fax:630-378-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361071472081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1881648962OtherPHYSICIAN NPI NUMBER