MEDICARE: INTERVENTIONAL PAIN & TREATMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1376099390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN & TREATMENT CENTER

Provider Business Mailing Address
First Line	:	1000 JORIE BLVD
Second Line	:	SUITE 370
City	:	OAK BROOK
State	:	IL
Zip	:	60523-2214
Country	:	US
Telephone Number	:	630-417-4307
Fax Number	:

Provider Business Practice Location Address
First Line	:	9079 KATY FWY
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77024-1653
Country	:	US
Telephone Number	:	630-417-4307
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANITA SINGH
Credential	:
Telephone Number	:	630-417-4307

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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