Provider Demographics
NPI:1255506697
Name:PREMIER PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:PREMIER PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARPAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-519-4701
Mailing Address - Street 1:1365 WILEY ROAD
Mailing Address - Street 2:SUITE 153
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4357
Mailing Address - Country:US
Mailing Address - Phone:847-519-4701
Mailing Address - Fax:847-519-4707
Practice Address - Street 1:1365 WILEY ROAD
Practice Address - Street 2:SUITE 153
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4357
Practice Address - Country:US
Practice Address - Phone:847-519-4701
Practice Address - Fax:847-519-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-27
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 207LP2900X
IL036120219207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL217075Medicare PIN
IL217074Medicare PIN