Provider Demographics
NPI:1376221473
Name:ILLINOIS PAIN TREATMENT INSTITUTE, LTD
Entity Type:Organization
Organization Name:ILLINOIS PAIN TREATMENT INSTITUTE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:PRUNSKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-289-8822
Mailing Address - Street 1:431 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3805
Mailing Address - Country:US
Mailing Address - Phone:847-289-8822
Mailing Address - Fax:847-289-0815
Practice Address - Street 1:2455 DEAN ST STE 3G
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4830
Practice Address - Country:US
Practice Address - Phone:847-289-8822
Practice Address - Fax:847-289-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty