Healthcare Provider Details

I. General information

NPI: 1932159191
Provider Name (Legal Business Name): UNITED PAIN SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 W 177TH ST
HAZEL CREST IL
60429-2001
US

IV. Provider business mailing address

PO BOX 129
PLAINFIELD IL
60544-0129
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-1256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number042.618283
License Number StateIL

VIII. Authorized Official

Name: DR. VOLODIMIR Z MARKIV
Title or Position: OWNER
Credential: MD
Phone: 815-834-7200