MEDICARE: CHICAGO PAIN & HEADACHE CLINIC, LTD

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	261QH0100X	Health Service Clinic/Center	036117439	IL

General Provider Information

NPI Number	:	1376782557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO PAIN & HEADACHE CLINIC, LTD

Provider Business Mailing Address
First Line	:	3314 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4035
Country	:	US
Telephone Number	:	773-277-7700
Fax Number	:	773-277-5100

Provider Business Practice Location Address
First Line	:	3314 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4035
Country	:	US
Telephone Number	:	773-277-7700
Fax Number	:	773-277-5100

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. BERNARDO SAAVEDRA
Credential	:	M.D.
Telephone Number	:	773-277-7700

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	02/12/2009

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