Organization
GREAT RIVER PAIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANJAY SUNDAR MD (OWNER)
(312) 613-9999
Entity
Organization
Contact information
Practice address
1634 AVENUE OF THE CITIES, MOLINE, IL 61265-4860
(309) 762-9711
(309) 762-9747
Mailing address
1634 AVENUE OF THE CITIES, MOLINE, IL 61265-4860
(309) 762-9711
(309) 762-9747
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
036118384
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036118384
LICENSE
IL
Enumeration date
10/11/2012
Last updated
10/11/2012
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