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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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