Provider Demographics
NPI:1033155080
Name:INTERVENTIONAL PAIN MANAGEMENT, LTD.
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN MANAGEMENT, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:POLLACHEK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-474-7650
Mailing Address - Street 1:18221 TORRENCE AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2870
Mailing Address - Country:US
Mailing Address - Phone:708-895-9450
Mailing Address - Fax:
Practice Address - Street 1:10220 WICKER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9424
Practice Address - Country:US
Practice Address - Phone:219-515-6943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-01-19
Deactivation Date:2013-08-28
Deactivation Code:
Reactivation Date:2015-10-14
Provider Licenses
StateLicense IDTaxonomies
IL60548471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty