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General NPI Number Information
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NPI Number | 1689682858
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND ADVANCED PAIN AND HEADACHE CLINICS LTD
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 6626 W CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402
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Country | US
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Telephone | 708-788-7246
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Fax | 708-788-7267
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Provider Business Mailing Address
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Address Line | PO BOX 56769
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City | CHICAGO
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State | IL
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Zip | 60656-0769
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Country | US
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Telephone | 708-788-1246
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Fax | 708-788-7247
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Authorized Official
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Title or Position | PRESIDENT
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Name | OSSAMA F ABDELLALIF
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Credential |
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Telephone | 708-788-7246
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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 |
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License Number State |
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