Provider Demographics
NPI:1376669721
Name:PAIN NET MEDICAL GROUP
Entity Type:Organization
Organization Name:PAIN NET MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-878-7909
Mailing Address - Street 1:5252 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2448
Mailing Address - Country:US
Mailing Address - Phone:773-878-7909
Mailing Address - Fax:773-878-2311
Practice Address - Street 1:5252 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2448
Practice Address - Country:US
Practice Address - Phone:773-878-7909
Practice Address - Fax:773-878-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1633119OtherBLUE CROSS BLUE SHEILD
1633119OtherBLUE CROSS BLUE SHEILD