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
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