Basic Information
| Provider Information | |||||||||
| NPI: | 1053425454 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAIN THERAPY ASSOCIATES LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 627 W. OAK STREET | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473525511 | ||||||||
| FaxNumber: | 8473525585 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 S ROSELLE RD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601932971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473525511 | ||||||||
| FaxNumber: | 8473525585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 04/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | DABAH | ||||||||
| AuthorizedOfficialFirstName: | WAJDE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8473525511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.