Healthcare Provider Details

I. General information

NPI: 1205090578
Provider Name (Legal Business Name): HOLISTIC SCIENCE PAIN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 129TH INFANTRY DRIVE
JOLIET IL
60435
US

IV. Provider business mailing address

105 129TH INFANTRY DRIVE
JOLIET IL
60435
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-7200
  • Fax:
Mailing address:
  • Phone: 815-725-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036107324
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036107324
License Number StateIL

VIII. Authorized Official

Name: DR. ASAD AKRAM CHEEMA
Title or Position: OWNER
Credential: MD
Phone: 815-725-7200