Healthcare Provider Details

I. General information

NPI: 1124376736
Provider Name (Legal Business Name): ILLINOIS SPINE INSTITUTE,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E CONGRESS PKWY STE E
CRYSTAL LAKE IL
60014-6248
US

IV. Provider business mailing address

500 W GOLF RD STE 101
SCHAUMBURG IL
60195-3503
US

V. Phone/Fax

Practice location:
  • Phone: 847-519-9700
  • Fax: 847-519-9760
Mailing address:
  • Phone: 847-519-9700
  • Fax: 847-519-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BABAK LAMI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-519-9700