Provider Demographics
NPI:1144739582
Name:MIDWEST INTERVENTIONAL PAIN SOLUTIONS LLC
Entity type:Organization
Organization Name:MIDWEST INTERVENTIONAL PAIN SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
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 572
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60454-0572
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:708-571-3669
Practice Address - Fax:708-630-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty