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General NPI Number Information
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NPI Number | 1134863749
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Entity Type | Organization
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Legal Business Name | NORTHSTAR REHAB PAIN CLINICS PLLC
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 131 E PARK AVE STE 103
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2858
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Country | US
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Telephone | 847-393-6246
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Fax |
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Provider Business Mailing Address
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Address Line | 1236 MCDANIELS AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3645
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANJUM KHAN
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Credential | MD
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Telephone | 312-813-6593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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