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General NPI Number Information
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NPI Number | 1902956469
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Entity Type | Organization
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Legal Business Name | DUPAGE PAIN CONSULTANTS, LLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 09/22/2012
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Provider Practice Location Address
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Address Line | 1971 GOWDEY RD STE. 103
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City | NAPERVILLE
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State | IL
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Zip | 60563-4232
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Country | US
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Telephone | 630-778-7300
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Fax | 630-778-7117
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Provider Business Mailing Address
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Address Line | 1971 GOWDEY RD STE. 103
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City | NAPERVILLE
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State | IL
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Zip | 60563-4232
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Country | US
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Telephone | 630-778-7300
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Fax | 630-778-7117
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAMES M KELLY
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Credential | M.D.
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Telephone | 630-778-7300
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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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