Healthcare Provider Details

I. General information

NPI: 1154334779
Provider Name (Legal Business Name): RX PAIN MANAGEMENT GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 S HALSTED STREET
CHICAGO IL
60608-6707
US

IV. Provider business mailing address

3405 S HALSTED STREET
CHICAGO IL
60608-6707
US

V. Phone/Fax

Practice location:
  • Phone: 773-247-2131
  • Fax: 773-247-3110
Mailing address:
  • Phone: 773-247-2131
  • Fax: 773-247-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036088691
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number036088691
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number036088691
License Number StateIL

VIII. Authorized Official

Name: MS. YAN DENG
Title or Position: MANAGER
Credential:
Phone: 773-247-2131