MEDICARE: ADVANCED PAIN AND REHAB MD, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1538398466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PAIN AND REHAB MD, SC

Provider Business Mailing Address
First Line	:	552 W OAKDALE AVE
Second Line	:	LOWER LEVEL
City	:	CHICAGO
State	:	IL
Zip	:	60657-5706
Country	:	US
Telephone Number	:	773-525-8744
Fax Number	:	773-525-6989

Provider Business Practice Location Address
First Line	:	3718 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4105
Country	:	US
Telephone Number	:	773-348-1711
Fax Number	:	773-348-1057

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BARRY RING
Credential	:
Telephone Number	:	773-525-6988

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	04/11/2011

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