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General NPI Number Information
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NPI Number | 1083952717
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Entity Type | Organization
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Legal Business Name | THE GHALAMBOR INSTITUTE LLC
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 3601 E LAKE CTR SUITE 400
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City | QUINCY
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State | IL
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Zip | 62305-5873
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Country | US
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Telephone | 217-222-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 EAST LAKE CENTRE DRIVE SUITE 400
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City | QUINCY
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State | IL
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Zip | 62305
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Country | US
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Telephone | 217-222-4567
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Fax |
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Authorized Official
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Title or Position | OWNDER
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Name | OMID GHALAMBOR
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Credential | MD
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Telephone | 217-222-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036114432
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License Number State | IL
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