Healthcare Provider Details

I. General information

NPI: 1982988663
Provider Name (Legal Business Name): INNOVATIVE PAIN SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S ARLINGTON HEIGHTS RD SUITE 165
ARLINGTON HEIGHTS IL
60005-4185
US

IV. Provider business mailing address

2101 S ARLINGTON HEIGHTS RD SUITE 165
ARLINGTON HEIGHTS IL
60005-4185
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-6800
  • Fax: 847-593-6803
Mailing address:
  • Phone: 847-593-6800
  • Fax: 847-593-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036122435
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036127880
License Number StateIL

VIII. Authorized Official

Name: DR. PAUL ANTHONY MARSIGLIA
Title or Position: MANAGING MEMBER
Credential: D.O.
Phone: 847-593-6800