Healthcare Provider Details

I. General information

NPI: 1497437792
Provider Name (Legal Business Name): GATEWAY SPINE AND PAIN PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SALT CREEK LN STE 350
HINSDALE IL
60521-8612
US

IV. Provider business mailing address

329 REMINGTON BLVD STE 205
BOLINGBROOK IL
60440-5817
US

V. Phone/Fax

Practice location:
  • Phone: 630-226-1130
  • Fax: 630-226-1134
Mailing address:
  • Phone: 630-226-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SCHLEMBACH
Title or Position: VP OPERATIONS AND COMPLIANCE
Credential:
Phone: 636-980-6500