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General NPI Number Information
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NPI Number | 1306135298
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Entity Type | Organization
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Legal Business Name | DMG PAIN MANAGEMENT SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 2940 ROLLINGRIDGE RD STE 200
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City | NAPERVILLE
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State | IL
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Zip | 60564-4226
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Country | US
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Telephone | 630-303-5304
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Fax | 630-527-0417
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Provider Business Mailing Address
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Address Line | 2940 ROLLINGRIDGE RD STE 200
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City | NAPERVILLE
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State | IL
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Zip | 60564-4226
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Country | US
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Telephone | 630-303-5304
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Fax | 630-527-0417
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN J GASHKOFF
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Credential | MD
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Telephone | 630-303-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7003162
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License Number State | IL
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