# GREAT LAKE PAIN PHYSICIANS, LTD.

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

## Provider details

- **NPI number:** 1023066420
- **Authorized official:** MR. KENDALL R. LUTZ (BILLING MANAGER)
- **Authorized official phone:** (847) 836-7015

## Contact information

- **Practice address:** 200 S GREENLEAF ST, SUITE A, GURNEE, IL 60031-3398
- **Practice address phone:** (847) 244-6464
- **Mailing address:** 185 PENNY AVE, EAST DUNDEE, IL 60118-1454
- **Mailing address phone:** (847) 836-7015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 09/11/2025