Provider Demographics
NPI:1306386644
Name:ADVANCED PAIN AND ANESTHESIA CONSULTANTS,PC
Entity Type:Organization
Organization Name:ADVANCED PAIN AND ANESTHESIA CONSULTANTS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-865-3819
Mailing Address - Street 1:5215 N CALIFORNIA AVE STE F715
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7014
Mailing Address - Country:US
Mailing Address - Phone:219-865-3819
Mailing Address - Fax:219-865-5401
Practice Address - Street 1:5215 N CALIFORNIA AVE STE F715
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7014
Practice Address - Country:US
Practice Address - Phone:773-728-4296
Practice Address - Fax:773-728-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1417370002Medicare NSC