MEDICARE: ADVANCED PAIN CARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01628160	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1619190386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PAIN CARE MD SC

Provider Business Mailing Address
First Line	:	2626 N LAKEVIEW AVE
Second Line	:	#2707
City	:	CHICAGO
State	:	IL
Zip	:	60614-6173
Country	:	US
Telephone Number	:	773-525-6988
Fax Number	:	773-525-6989

Provider Business Practice Location Address
First Line	:	4500 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1934
Country	:	US
Telephone Number	:	773-525-6988
Fax Number	:	773-525-6989

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	04/11/2011

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