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General NPI Number Information
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NPI Number | 1306185913
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Entity Type | Organization
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Legal Business Name | ILLINOIS PAIN SPECIALISTS, LLC
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 1000 RANDALL RD SUITE 225
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City | GENEVA
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State | IL
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Zip | 60134-2590
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Country | US
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Telephone | 630-845-4099
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Fax | 630-845-4098
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Provider Business Mailing Address
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Address Line | 1000 RANDALL RD SUITE 225
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City | GENEVA
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State | IL
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Zip | 60134-2590
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Country | US
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Telephone | 630-845-4099
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Fax | 630-845-4098
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOJAN PAVLOVIC
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Credential | M.D.
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Telephone | 773-307-3009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 4301089505
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License Number State | MI
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