Healthcare Provider Details

I. General information

NPI: 1265824734
Provider Name (Legal Business Name): ELGIN MEDICAL PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 E WOODFIELD RD.
SCHAUMBURG IL
60173
US

IV. Provider business mailing address

1116 PALMER CT
CRYSTAL LAKE IL
60014-6938
US

V. Phone/Fax

Practice location:
  • Phone: 815-404-3064
  • Fax: 847-697-3475
Mailing address:
  • Phone: 815-404-3064
  • Fax: 847-697-3475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL JAMES HARTLETT
Title or Position: CEO
Credential: D.C.
Phone: 815-404-3064