Provider Demographics
NPI:1376867879
Name:CENTER FOR INTERVENTIONAL PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:CENTER FOR INTERVENTIONAL PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-607-1000
Mailing Address - Street 1:2100 CLEARWATER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1931
Mailing Address - Country:US
Mailing Address - Phone:630-607-1000
Mailing Address - Fax:630-607-1002
Practice Address - Street 1:2100 CLEARWATER DR STE 100
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1931
Practice Address - Country:US
Practice Address - Phone:630-607-1000
Practice Address - Fax:630-607-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain