NPI 1437519410

Hegewisch Spine Pain Center LLC

Organisation Exclusive Provider Organization Berwyn, IL

Practice location

Address: 6626 W Cermak Rd, Berwyn, IL 60402
Phone: (708) 788-7246
Mailing address: 7653 W Montrose Ave, Norridge, IL 60706

Authorised official

Name: Natalya Smirnova
Title: Office Manager
Phone: (708) 788-7246

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 036108759 (IL)

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Registry record

NPI: 1437519410
Entity type: Organization
NPI issued: 3 Mar 2016
Record last updated: 3 Mar 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.