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General NPI Number Information
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NPI Number | 1568087583
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Entity Type | Organization
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Legal Business Name | SYNERGY INTEGRATIVE HEADACHE CENTER LTD
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 191 WAUKEGAN RD STE 300
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City | NORTHFIELD
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State | IL
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Zip | 60093-2744
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Country | US
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Telephone | 773-948-7557
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Fax |
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Provider Business Mailing Address
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Address Line | 191 WAUKEGAN RD STE 300
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City | NORTHFIELD
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State | IL
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Zip | 60093-2744
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Country | US
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Telephone | 773-948-7557
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Fax | 773-948-7558
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDER FEOKTISTOV
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Credential | MD
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Telephone | 773-729-0835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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