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General NPI Number Information
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NPI Number | 1255956777
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Entity Type | Organization
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Legal Business Name | MODERN PAIN CONSULTANTS
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 1890 SILVER CROSS BLVD STE 315
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City | NEW LENOX
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State | IL
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Zip | 60451-9605
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Country | US
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Telephone | 815-416-1224
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Fax | 815-416-1220
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Provider Business Mailing Address
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Address Line | 907 N ELM ST STE 101
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City | HINSDALE
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State | IL
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Zip | 60521-3644
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Country | US
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Telephone | 708-482-4500
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Fax | 708-482-4502
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ALEXIS MUNOZ
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Credential |
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Telephone | 815-416-1224
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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 |
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License Number State |
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