Healthcare Provider Details

I. General information

NPI: 1386948321
Provider Name (Legal Business Name): ELITE PAIN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 S PULASKI RD
CHICAGO IL
60652-3633
US

IV. Provider business mailing address

13011 RIDGEWOOD DR
PALOS PARK IL
60464-2512
US

V. Phone/Fax

Practice location:
  • Phone: 773-762-8132
  • Fax: 773-762-8133
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALANNA JEFFERSON
Title or Position: CODER
Credential: CPC
Phone: 312-882-7578