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General NPI Number Information
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NPI Number | 1972883387
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Entity Type | Organization
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Legal Business Name | QUALITY PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 10/18/2015
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Provider Practice Location Address
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Address Line | 8190 CASS AVE
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City | DARIEN
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State | IL
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Zip | 60561-5013
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Country | US
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Telephone | 630-333-0501
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Fax | 630-541-6028
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Provider Business Mailing Address
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Address Line | 2304 DUNMORE DR
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City | DARIEN
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State | IL
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Zip | 60561-8453
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Country | US
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Telephone | 630-930-2067
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Fax |
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Authorized Official
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Title or Position | ANESTHESIOLOGIST & PAIN PHYSICIAN
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Name | HUMAIRA KHATOON
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Credential | M.D.
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Telephone | 630-930-2067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036-095004
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License Number State | IL
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