Organization
PAIN MANAGEMENT SPECIALISTS LTD
Active
Organization
PAIN MANAGEMENT SPECIALISTS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEN WEBER (CREDENTIALING COORDINATOR)
(224) 231-4363
Entity
Organization
Contact information
Practice address
5215 N CALIFORNIA AVE STE 880, CHICAGO, IL 60625-7014
(773) 293-8900
Mailing address
PO BOX 631, LAKE FOREST, IL 60045-0631
(224) 231-4363
(866) 642-1525
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036105360
IL
208VP0000X
Pain Medicine Physician
036105360
IL
208VP0014X
Interventional Pain Medicine Physician
Primary
036105360
IL
Other
Enumeration date
06/02/2016
Last updated
06/02/2016
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