MEDICARE: AMERICAN PAIN INSTITUTE INC

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	207Q00000X	Family Medicine Physician	036086950	IL

General Provider Information

NPI Number	:	1740686658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN PAIN INSTITUTE INC

Provider Business Mailing Address
First Line	:	1753 W CHICAGO AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60622-5009
Country	:	US
Telephone Number	:	312-226-4556
Fax Number	:	312-226-3775

Provider Business Practice Location Address
First Line	:	1753 W CHICAGO AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60622-5009
Country	:	US
Telephone Number	:	312-226-4556
Fax Number	:	312-226-3775

Authorized Official
Title or Position	:	OWNER
Name	:	JERRY DALE LEECH
Credential	:
Telephone Number	:	312-226-4556

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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Directions to “AMERICAN PAIN INSTITUTE INC ” Practice Location

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