Provider Demographics
NPI:1093146862
Name:COMPREHENSIVE PAIN CARE CENTER INC
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN CARE CENTER INC
Other - Org Name:COMPREHENSIVE PAIN CARE CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZZAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALKUDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-351-4686
Mailing Address - Street 1:8S180 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5542
Mailing Address - Country:US
Mailing Address - Phone:708-479-6522
Mailing Address - Fax:708-286-6461
Practice Address - Street 1:8S180 S VINE ST
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5542
Practice Address - Country:US
Practice Address - Phone:708-479-6522
Practice Address - Fax:708-286-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113149207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113149Medicaid