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General NPI Number Information
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NPI Number | 1356852735
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Entity Type | Organization
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Legal Business Name | CHICAGO PAIN RELIEF PC
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 6715 KINGERY HWY
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5142
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Country | US
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Telephone | 630-537-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 6715 KINGERY HWY
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5142
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Country | US
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Telephone | 630-537-1125
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARIA DAVILA
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Credential |
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Telephone | 630-537-1125
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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 | 036128363
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License Number State | IL
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