# SPECIALTY PAIN ANESTHESIA REHABILITATION CONSULTANTS LLC

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

## Provider details

- **NPI number:** 1316580541
- **Authorized official:** JOHN LEUTHNER (OWNER)
- **Authorized official phone:** (847) 363-0863

## Contact information

- **Practice address:** 256 E GRAND AVE, FOX LAKE, IL 60020-1684
- **Practice address phone:** (847) 370-6712
- **Mailing address:** 6615 GRAND AVE \# 1037, GURNEE, IL 60031-4591
- **Mailing address phone:** (847) 363-0863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 10/21/2019
- **Last updated:** 08/23/2024