Basic Information
| Provider Information | |||||||||
| NPI: | 1497884159 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELGIN PAIN & HEADACHE CENTER, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 PENNY AVE | ||||||||
| Address2: | |||||||||
| City: | EAST DUNDEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601181454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478367015 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1975 LIN LOR LN | ||||||||
| Address2: | SUITE 175 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477174790 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ONWUTA | ||||||||
| AuthorizedOfficialFirstName: | J. NNAEMEKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8477174790 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | IL | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | IL | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.