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General NPI Number Information
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NPI Number | 1801146303
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND PAIN MANAGEMENT INSTITUTE, INC.
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 420 S. SCHMIDT ROAD STE. 240
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2634
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Country | US
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Telephone | 630-312-4562
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Fax | 630-312-6651
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Provider Business Mailing Address
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Address Line | 420 S. SCHMIDT ROAD STE. 110
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1737
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Country | US
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Telephone | 630-312-4562
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Fax | 630-312-6651
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Authorized Official
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Title or Position | SOLE OWNER
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Name | GORAN TUBIC
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Credential | MD
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Telephone | 630-312-4562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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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 | IL
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