Healthcare Provider Details

I. General information

NPI: 1104013473
Provider Name (Legal Business Name): GATEWAY SPINE AND PAIN PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 REMINGTON BLVD SUITE G
BOLINGBROOK IL
60440-3656
US

IV. Provider business mailing address

215 REMINGTON BLVD SUITE G
BOLINGBROOK IL
60440-3656
US

V. Phone/Fax

Practice location:
  • Phone: 630-226-1130
  • Fax: 630-226-1134
Mailing address:
  • Phone: 630-226-1130
  • Fax: 630-226-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN K HONG
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 630-226-1130