Healthcare Provider Details

I. General information

NPI: 1447446422
Provider Name (Legal Business Name): FIBROMYALAGIA TREATMENT CENTERS OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD SUITE 535
ELK GROVE VILLAGE IL
60007-3361
US

IV. Provider business mailing address

4332 N ELSTON AVE
CHICAGO IL
60641-2144
US

V. Phone/Fax

Practice location:
  • Phone: 847-290-0924
  • Fax: 847-290-0996
Mailing address:
  • Phone: 773-604-5321
  • Fax: 773-604-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: RICHARD SYMON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-604-5321