# HEGEWISCH SPINE PAIN CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437519410
- **Authorized official:** NATALYA SMIRNOVA (OFFICE MANAGER)
- **Authorized official phone:** (708) 788-7246

## Contact information

- **Practice address:** 6626 W CERMAK RD, BERWYN, IL 60402
- **Practice address phone:** (708) 788-7246
- **Mailing address:** 7653 W MONTROSE AVE, NORRIDGE, IL 60706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 036108759 | IL | Yes |

## Other

- **Enumeration date:** 03/03/2016
- **Last updated:** 03/03/2016