1750631479 NPI number — SPERO PAIN RELIEF THERAPY OF ILLINOIS, PC

Table of content: (NPI 1750631479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750631479 NPI number — SPERO PAIN RELIEF THERAPY OF ILLINOIS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPERO PAIN RELIEF THERAPY OF ILLINOIS, PC
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:
1750631479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 MILWAUKEE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERWOODS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-3512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-520-7111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERWOODS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-520-7111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BLACK
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
708-363-5939

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com