Healthcare Provider Details

I. General information

NPI: 1003594102
Provider Name (Legal Business Name): ILLINOIS PAIN TREATMENT INSTITUTE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E DEVON AVE STE 152
ITASCA IL
60143-3136
US

IV. Provider business mailing address

431 SUMMIT ST
ELGIN IL
60120-3805
US

V. Phone/Fax

Practice location:
  • Phone: 847-289-8822
  • Fax: 847-289-0815
Mailing address:
  • Phone: 847-289-8822
  • Fax: 847-289-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHADI ISKANDAR YAACOUB
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 847-289-8822