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General NPI Number Information
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NPI Number | 1417286378
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Entity Type | Organization
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Legal Business Name | UNITED PAIN SURGICORE SC
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 3330 W 177TH STREET
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City | HAZEL CREST
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State | IL
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Zip | 60429-0000
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Country | US
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Telephone | 630-267-0299
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Fax |
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Provider Business Mailing Address
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Address Line | P.O BOX 129
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City | PLAINFIELD
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State | IL
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Zip | 60544-0129
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Country | US
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Telephone | 630-267-0299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VOLODIMIR MARKIV
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Credential |
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Telephone | 630-267-0299
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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 | 042619555
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License Number State | IL
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