Organization
GUARDIAN HEADACHE & PAIN MANAGEMENT INSTITUTE LLC
Active
Organization
GUARDIAN HEADACHE & PAIN MANAGEMENT INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN TAIMOORAZY MD (OWNER)
(309) 664-1747
Entity
Organization
Contact information
Practice address
2203 EASTLAND DR, SUITE 7, BLOOMINGTON, IL 61704-7918
(309) 808-1700
(847) 615-2858
Mailing address
PO BOX 5488, PEORIA, IL 61601-5488
(800) 444-6110
(847) 615-2858
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
036086706
IL
208VP0014X
Interventional Pain Medicine Physician
Primary
036086706
IL
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
01/14/2011
Last updated
07/21/2015
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