Basic Information
| Provider Information | |||||||||
| NPI: | 1154374767 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN MANAGEMENT INSTITUTE CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4985 DEPARTMENT | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601225314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154647212 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10181 W LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604231274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154647212 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 12/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | ANWAR | ||||||||
| AuthorizedOfficialFirstName: | ZAKI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 8154647212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 036090578 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0163014 | 01 | IL | BLUE CROSS | OTHER | 036090578 | 05 | IL | MEDICAID | P00025045 | 01 | IL | RR MEDICARE | OTHER |