Healthcare Provider Details

I. General information

NPI: 1194943407
Provider Name (Legal Business Name): UNIVERSITY PAIN PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MAPLE AVENUE
OAK PARK IL
60304
US

IV. Provider business mailing address

PO BOX 1151
GLENVIEW IL
60025
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-3971
  • Fax:
Mailing address:
  • Phone: 312-942-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH TUMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 312-942-3135