# GUARDIAN INTERVENTIONAL PAIN MANAGEMENT INSTITUTE LLC

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

## Provider details

- **NPI number:** 1053840124
- **Authorized official:** MOHAMED EL-ANSARY M.D. (OWNER)
- **Authorized official phone:** (217) 274-9720

## Contact information

- **Practice address:** 2203 EASTLAND DR STE 7, BLOOMINGTON, IL 61704-7924
- **Practice address phone:** (309) 808-1700
- **Mailing address:** PO BOX 570, LAKE FOREST, IL 60045-0570

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/12/2017
- **Last updated:** 06/12/2017