Basic Information
| Provider Information | |||||||||
| NPI: | 1265917892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED INTERVENTIONAL PAIN SOLUTIONS LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 486 | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600450486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 921 SHERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LAKE BLUFF | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600442203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2018 | ||||||||
| LastUpdateDate: | 09/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | GASTEVSKI | ||||||||
| AuthorizedOfficialFirstName: | DRAGAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3127259454 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.