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General NPI Number Information
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NPI Number | 1801964473
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Entity Type | Organization
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Legal Business Name | PAIN CENTERS OF CHICAGO LLC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 1305 WALT WHITMAN RD STE 300
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City | MELVILLE
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State | NY
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Zip | 11747-4300
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Country | US
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Telephone | 516-945-3000
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Fax | 815-729-0459
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | BEDFORD PARK
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State | IL
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Zip | 60499
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Country | US
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Telephone | 815-729-0450
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Fax | 815-729-0459
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MATTHEW WALSH
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Credential | MD
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Telephone | 516-945-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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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 | 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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Taxonomy #3
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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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