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General NPI Number Information
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NPI Number | 1750631479
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Entity Type | Organization
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Legal Business Name | SPERO PAIN RELIEF THERAPY OF ILLINOIS, PC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1105 MILWAUKEE AVE
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City | RIVERWOODS
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State | IL
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Zip | 60015-3512
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Country | US
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Telephone | 847-520-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 MILWAUKEE AVE
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City | RIVERWOODS
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State | IL
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Zip | 60015-3512
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Country | US
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Telephone | 847-520-7111
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Fax |
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | NORMAN J BLACK
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Credential |
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Telephone | 708-363-5939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State | IL
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