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General NPI Number Information
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NPI Number | 1801185616
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Entity Type | Organization
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Legal Business Name | ILLINOIS SPINE AND PAIN CENTER SC
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 1002 INTERSTATE DR OLYMPIAN SURGICAL SUITES
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1465
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Country | US
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Telephone | 217-974-9366
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Fax | 800-801-3765
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Provider Business Mailing Address
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Address Line | PO BOX 736909
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City | CHICAGO
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State | IL
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Zip | 60673-1424
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Country | US
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Telephone | 217-974-9366
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Fax | 800-801-3765
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | DR. BRIAN OGAN
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Credential | M.D.
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Telephone | 217-347-2332
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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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