1801146303 NPI number — CHICAGOLAND PAIN MANAGEMENT INSTITUTE, INC.

Table of content: (NPI 1801146303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801146303 NPI number — CHICAGOLAND PAIN MANAGEMENT INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGOLAND PAIN MANAGEMENT INSTITUTE, INC.
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:
1801146303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 S. SCHMIDT ROAD
Provider Second Line Business Mailing Address:
STE. 110
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-312-4562
Provider Business Mailing Address Fax Number:
630-312-6651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 S. SCHMIDT ROAD
Provider Second Line Business Practice Location Address:
STE. 240
Provider Business Practice Location Address City Name:
BOLINGBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60440-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-312-4562
Provider Business Practice Location Address Fax Number:
630-312-6651
Provider Enumeration Date:
09/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TUBIC
Authorized Official First Name:
GORAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
630-312-4562

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , 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)





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