Provider Demographics
NPI:1164567236
Name:ADVANCED PAIN CONSULTANTS, S.C.
Entity Type:Organization
Organization Name:ADVANCED PAIN CONSULTANTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KONDELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-607-1000
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0129
Mailing Address - Country:US
Mailing Address - Phone:800-843-0355
Mailing Address - Fax:815-834-7211
Practice Address - Street 1:2100 CLEARWATER DR STE 100
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1931
Practice Address - Country:US
Practice Address - Phone:630-607-1000
Practice Address - Fax:630-607-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070815Medicaid
IL215390Medicare PIN
IL036070815Medicaid