Healthcare Provider Details

I. General information

NPI: 1093330516
Provider Name (Legal Business Name): MODERN PAIN CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 07/10/2021
Certification Date: 07/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST STE 605
MORRIS IL
60450-3133
US

IV. Provider business mailing address

907 N ELM ST STE 101
HINSDALE IL
60521-3644
US

V. Phone/Fax

Practice location:
  • Phone: 815-416-1224
  • Fax: 815-416-1220
Mailing address:
  • Phone: 708-482-4500
  • Fax: 708-482-4502

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: ALEXIS MUNOZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 815-416-1224