Healthcare Provider Details

I. General information

NPI: 1043631856
Provider Name (Legal Business Name): IMMEDIATE PAIN CARE OF SCHAUMBURG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HIGGINS RD
SCHAUMBURG IL
60173-5142
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1234
US

V. Phone/Fax

Practice location:
  • Phone: 847-805-9111
  • Fax: 847-805-9115
Mailing address:
  • Phone: 847-912-2411
  • Fax: 630-701-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STUART BERNSEN
Title or Position: CEO
Credential:
Phone: 847-912-2411