Provider Demographics
NPI:1093330516
Name:MODERN PAIN CONSULTANTS
Entity Type:Organization
Organization Name:MODERN PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-416-1224
Mailing Address - Street 1:907 N ELM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3644
Mailing Address - Country:US
Mailing Address - Phone:708-482-4500
Mailing Address - Fax:708-482-4502
Practice Address - Street 1:1802 N DIVISION ST STE 605
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3133
Practice Address - Country:US
Practice Address - Phone:815-416-1224
Practice Address - Fax:815-416-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1477081263OtherNPI
IL1538285614OtherNPI
IL1104082320OtherNPI
IL1891113247OtherNPI
IL1780214718OtherNPI
IL1992758965OtherNPI