Healthcare Provider Details

I. General information

NPI: 1528233111
Provider Name (Legal Business Name): APPLIED PAIN INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S MERCER AVE
BLOOMINGTON IL
61701-7107
US

IV. Provider business mailing address

1015 S MERCER AVE
BLOOMINGTON IL
61701-7107
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-0088
  • Fax: 309-662-0089
Mailing address:
  • Phone: 309-662-0088
  • Fax: 309-662-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number36-098820
License Number StateIL

VIII. Authorized Official

Name: MELISSA SUE BRADY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 309-662-0088