Provider Demographics
NPI:1275683419
Name:PAIN TREATMENT CENTERS OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:PAIN TREATMENT CENTERS OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABUSHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-460-9000
Mailing Address - Street 1:16514 SOUTH 106TH COURT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-460-9000
Mailing Address - Fax:708-460-0094
Practice Address - Street 1:16514 SOUTH 106TH COURT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-460-9000
Practice Address - Fax:708-460-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20562582OtherTAX ID NUMBER