Midwest Pain & Spine Center, LLC

NPI #1679944334 in Peoria, Illinois

Provider Information

NPI Number: 1679944334
Entity Type: Organization
Organization Name: Midwest Pain & Spine Center, LLC
Primary Specialty: Specialist
Enumeration Date: Oct 7, 2015
Last Updated: Oct 23, 2015

Practice Location

Address: 5401 N KNOXVILLE AVE
Address 2: SUITE 416
City: Peoria
State: Illinois
ZIP Code: 61614-5098
Phone: (309) 692-7246

Authorized Official

Name: GAYLE MUCCIANTE
Title: PRACTICE ADMINISTRATOR
Phone: (309) 692-7246

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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