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General NPI Number Information
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NPI Number | 1447446422
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Entity Type | Organization
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Legal Business Name | FIBROMYALAGIA TREATMENT CENTERS OF AMERICA
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 800 BIESTERFIELD RD SUITE 535
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3361
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Country | US
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Telephone | 847-290-0924
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Fax | 847-290-0996
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Provider Business Mailing Address
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Address Line | 4332 N ELSTON AVE
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City | CHICAGO
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State | IL
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Zip | 60641-2144
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Country | US
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Telephone | 773-604-5321
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Fax | 773-604-5231
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RICHARD SYMON
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Credential |
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Telephone | 773-604-5321
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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 |
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License Number State | IL
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