Organization
CHICAGO PAIN MEDICINE CENTER
Active
Organization
CHICAGO PAIN MEDICINE CENTER
Active
Parent organization
CHICAGO PAIN MEDICINE CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHICAGO PAIN MEDICINE CENTER
Authorized official
JAMES R DIESFELD MD (PRESIDENT)
(773) 868-6824
Entity
Organization
Contact information
Practice address
6307 S STEWART AVE STE 205, CHICAGO, IL 60621-3116
(773) 868-6824
(773) 868-6828
Mailing address
1044 N FRANCISCO AVE STE 404, CHICAGO, IL 60622-2743
(773) 868-6824
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
036.086023
IL
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01605512
BCBS
IL
05
—
036008623
—
IL
Enumeration date
11/21/2017
Last updated
07/09/2020
Update your record
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