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General NPI Number Information
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NPI Number | 1760894554
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Entity Type | Organization
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Legal Business Name | IMMEDIATE PAIN CARE OF EVANSTON, LLC
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 7986 SOLUTIONS CTR
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City | CHICAGO
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State | IL
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Zip | 60677-1016
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Country | US
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Telephone | 630-560-5439
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Fax | 630-701-1007
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Provider Business Mailing Address
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Address Line | 7986 SOLUTIONS CTR
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City | CHICAGO
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State | IL
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Zip | 60677-1016
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Country | US
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Telephone | 630-560-5439
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Fax | 630-701-1007
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Authorized Official
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Title or Position | CEO
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Name | STUART BERNSEN
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Credential |
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Telephone | 630-560-6506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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