1295811479 NPI number — ILLINOIS PAIN TREATMENT INSTITUTE, LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295811479 NPI number — ILLINOIS PAIN TREATMENT INSTITUTE, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ILLINOIS PAIN TREATMENT INSTITUTE, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295811479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
431 SUMMIT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-289-8822
Provider Business Mailing Address Fax Number:
847-289-0815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 SUMMIT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-289-8822
Provider Business Practice Location Address Fax Number:
847-289-0815
Provider Enumeration Date:
10/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YAACOUB
Authorized Official First Name:
CHADI
Authorized Official Middle Name:
ISKANDAR
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
847-289-8822

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CM 4844 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DA 3105 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1619144 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA 2780 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".