MEDICARE: MODERN PAIN MANAGEMENT SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1043161060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN PAIN MANAGEMENT SC

Provider Business Mailing Address
First Line	:	1795 N BUTTERFIELD RD STE 108
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-1212
Country	:	US
Telephone Number	:	773-818-1544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1795 N BUTTERFIELD RD STE 108
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-1212
Country	:	US
Telephone Number	:	773-818-1544
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	MARIAM EL-BAGHDADI
Credential	:
Telephone Number	:	504-905-9425

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	04/07/2026

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