Provider Demographics
NPI:1164451308
Name:MODERN PAIN CONSULTANTS
Entity Type:Organization
Organization Name:MODERN PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:708-482-4500
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 1:907 N ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3644
Practice Address - Country:US
Practice Address - Phone:708-482-4500
Practice Address - Fax:708-482-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL132321800OtherUS DEPT LABOR
IL720000088OtherMEDICARE RAILROAD
IL01608719OtherBLUE CROSS GRP ILLINOIS
IL050054545OtherMEDICARE RAILROAD
IL050054546OtherMEDICARE RAILROAD
IL720000089OtherMEDICARE RAILROAD
IL132321800OtherUS DEPT LABOR
ILCE9206Medicare PIN