Healthcare Provider Details

I. General information

NPI: 1073729026
Provider Name (Legal Business Name): ILLINOIS PHYSICIANS NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 W HIGGINS RD SUITE 485
CHICAGO IL
60631-2716
US

IV. Provider business mailing address

836 S ARLINGTON HEIGHTS RD #343
ELK GROVE VILLAGE IL
60007-3667
US

V. Phone/Fax

Practice location:
  • Phone: 847-303-0701
  • Fax: 847-303-0709
Mailing address:
  • Phone: 847-303-0701
  • Fax: 847-303-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN KIM
Title or Position: PRESIDENT
Credential:
Phone: 847-303-0701