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NPI Code Detail

MEDICARE: INTEGRATED PAIN MANAGEMENT SC

MEDICARE: INTEGRATED PAIN MANAGEMENT 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
1207LP2900XPain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number : 1962845289
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED PAIN MANAGEMENT SC
Provider Business Mailing Address
First Line : 244 E ROOSEVELT RD
Second Line :
City : LOMBARD
State : IL
Zip : 60148-4647
Country : US
Telephone Number : 312-842-4588
Fax Number : 630-495-7255
Provider Business Practice Location Address
First Line : 3412 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2416
Country : US
Telephone Number : 773-235-8000
Fax Number : 773-486-9320
Authorized Official
Title or Position : CEO/OWNER
Name : TIAN XIA
Credential : D.O.
Telephone Number : 312-842-4588
Provider Enumeration Date : 04/17/2013
Last Update Date : 04/17/2013

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Directions to “INTEGRATED PAIN MANAGEMENT SC ” Practice Location

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