Provider Demographics
NPI:1225385131
Name:INNOVATIVE PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:INNOVATIVE PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-593-6800
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:2101 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 165
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4185
Practice Address - Country:US
Practice Address - Phone:847-593-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE PAIN SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site