Organization
CHICAGO PAIN MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES R. DIESFELD M.D. (PRESIDENT)
(773) 868-6824
Entity
Organization
Contact information
Practice address
1044 N FRANCISCO AVE STE 404, CHICAGO, IL 60622-2743
(773) 868-6824
(773) 868-6828
Mailing address
1044 N FRANCISCO AVE STE 404, CHICAGO, IL 60622-2743
(773) 868-6824
(773) 868-6828
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
BLUE SHIELD OF ILLINOIS
IL
05
—
036086023
—
IL
Enumeration date
05/31/2006
Last updated
10/02/2020
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