Healthcare Provider Details

I. General information

NPI: 1669420055
Provider Name (Legal Business Name): PAIN CARE CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W DEMPSTER ST SUITE 405
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

185 PENNY AVE
EAST DUNDEE IL
60118-1454
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-2294
  • Fax:
Mailing address:
  • Phone: 847-836-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENDALL R. LUTZ
Title or Position: BILLING MANAGER
Credential:
Phone: 847-836-7015