Provider Demographics
NPI:1275034738
Name:UNIVERSITY PAIN PHYSICIANS LLC
Entity Type:Organization
Organization Name:UNIVERSITY PAIN PHYSICIANS LLC
Other - Org Name:UNIVERSITY PAIN CENTERS AT WESTCHESTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-3135
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:312-942-3138
Mailing Address - Fax:
Practice Address - Street 1:2450 WOLF ROAD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154
Practice Address - Country:US
Practice Address - Phone:708-483-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY PAIN PHYSICIANS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty