OrganizationActive
Midwest Pain & Spine Center, LLC
NPI 1679944334 · Specialist · Peoria, IL
Provider details
- NPI number
- 1679944334
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Gayle Mucciante, Practice Administrator(309) 692-7246
Specialties & taxonomies
Other Service Providers
Practice location
5401 N Knoxville Ave
Suite 416
Peoria, IL 61614-5098
Phone: (309) 692-7246
Fax: (309) 692-7226
Approximate (ZIP-level) locationGet directions
Mailing address
5401 N Knoxville Ave
Peoria, IL 61614-5098
Registry dates
- Enumerated
- 2015-10-07
- Last updated
- 2015-10-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.