Healthcare Provider Details

I. General information

NPI: 1164567236
Provider Name (Legal Business Name): ADVANCED PAIN CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CLEARWATER DR STE 100
OAK BROOK IL
60523-1931
US

IV. Provider business mailing address

2100 CLEARWATER DR STE 100
OAK BROOK IL
60523-1931
US

V. Phone/Fax

Practice location:
  • Phone: 630-607-1000
  • Fax: 630-607-1002
Mailing address:
  • Phone: 630-607-1000
  • Fax: 630-607-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS KONDELIS
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 630-607-1000