Healthcare Provider Details

I. General information

NPI: 1023958295
Provider Name (Legal Business Name): ELITE SPINE AND REGENERATIVE PAIN CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 INTERSTATE DR
CHAMPAIGN IL
61822-1465
US

IV. Provider business mailing address

406 BRIERHILL RD
DEERFIELD IL
60015-4402
US

V. Phone/Fax

Practice location:
  • Phone: 217-974-9366
  • Fax: 800-801-3765
Mailing address:
  • Phone: 217-974-9366
  • Fax: 800-801-3765

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: DR. BRIAN OGAN
Title or Position: OWNER
Credential: MD
Phone: 312-953-9793