Healthcare Provider Details

I. General information

NPI: 1295126373
Provider Name (Legal Business Name): HIGHLAND PARK PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE STE 144
HIGHLAND PARK IL
60035-3211
US

IV. Provider business mailing address

600 CENTRAL AVE STE 144
HIGHLAND PARK IL
60035-3211
US

V. Phone/Fax

Practice location:
  • Phone: 847-266-5656
  • Fax: 847-266-5658
Mailing address:
  • Phone: 847-266-5656
  • Fax: 847-266-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES ROBERT O'TOOLE
Title or Position: OWNER
Credential: D.C.
Phone: 847-266-5656