Organization
MIDWEST MINIMALLY INVASIVE SPINE SPECIALISTS SC
Active
Other names
Minimally Invasive Spine Specialist SC
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK J SWEENEY MD (OWNER)
(708) 390-2290
Entity
Organization
Contact information
Practice address
19110 DARVIN DR, SUITE C, MOKENA, IL 60448-8595
(708) 390-2290
(708) 390-2299
Mailing address
PO BOX 4037, AURORA, IL 60507-4037
(708) 390-2290
(708) 390-2299
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
042617626
IL
207T00000X
Neurological Surgery Physician
50004759A
IN
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
042617626
IN
207XS0117X
Orthopaedic Surgery of the Spine Physician
50004759A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632167
BC/BS
—
01
—
CK7919
RR MEDICARE
IN
01
—
DO9194
RR MEDICARE
IL
Enumeration date
12/07/2005
Last updated
03/19/2010
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