Provider Demographics
NPI:1316580541
Name:SPECIALTY PAIN ANESTHESIA REHABILITATION CONSULTANTS LLC
Entity Type:Organization
Organization Name:SPECIALTY PAIN ANESTHESIA REHABILITATION CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-363-0863
Mailing Address - Street 1:9445 INDIANAPOLIS BLVD # 1101
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2648
Mailing Address - Country:US
Mailing Address - Phone:847-363-0863
Mailing Address - Fax:
Practice Address - Street 1:1750 N RANDALL RD STE 160
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7902
Practice Address - Country:US
Practice Address - Phone:847-363-0863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty