Provider Demographics
NPI:1376259333
Name:DELTA PAIN CONSULTANTS
Entity Type:Organization
Organization Name:DELTA PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-769-7095
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0570
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:847-615-2858
Practice Address - Street 1:519 N CASS AVE UNIT 304
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1514
Practice Address - Country:US
Practice Address - Phone:630-470-6210
Practice Address - Fax:630-470-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty