MEDICARE: ILLINOIS CENTER FOR PAIN CONTROL LLC

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	:	1437556941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS CENTER FOR PAIN CONTROL LLC

Provider Business Mailing Address
First Line	:	10176 W 400 N
Second Line	:	SUITE B
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9008
Country	:	US
Telephone Number	:	219-809-9839
Fax Number	:	219-809-9841

Provider Business Practice Location Address
First Line	:	10176 W 400 N
Second Line	:	SUITE B
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9008
Country	:	US
Telephone Number	:	219-809-9839
Fax Number	:	219-809-9841

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SYED M QUADRI
Credential	:	DO
Telephone Number	:	312-262-6434

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	04/10/2025

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Directions to “ILLINOIS CENTER FOR PAIN CONTROL LLC ” Practice Location

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