Organization
GREAT LAKE PAIN PHYSICIANS LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZA DIACONESCU M.D. (MEDICAL DIRECTOR)
18479700885
Entity
Organization
Contact information
Practice address
15 TOWER CT, STE # 190, GURNEE, IL 60031-3336
(847) 970-0885
Mailing address
15 TOWER CT, STE # 190, GURNEE, IL 60031-3336
(847) 970-0885
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036-084312
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
036-084312
IL
208D00000X
General Practice Physician
036-084312
IL
208VP0014X
Interventional Pain Medicine Physician
036-084312
IL
Other
Enumeration date
05/23/2007
Last updated
11/25/2014
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