MEDICARE: CENTENNIAL MEDICAL GROUP IL 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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1831077528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTENNIAL MEDICAL GROUP IL LLC

Provider Business Mailing Address
First Line	:	4454 N DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-5286
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 N CICERO AVE STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1649
Country	:	US
Telephone Number	:	702-839-1203
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID LANZKOWSKY
Credential	:	MD
Telephone Number	:	702-839-1203

Provider Enumeration Date	:	08/22/2025
Last Update Date	:	08/22/2025

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Directions to “CENTENNIAL MEDICAL GROUP IL LLC ” Practice Location

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