Provider Demographics
NPI:1417385790
Name:ILLINOIS BACK & NECK INSTITUTE, PLLC
Entity Type:Organization
Organization Name:ILLINOIS BACK & NECK INSTITUTE, PLLC
Other - Org Name:ILLINOIS BACK & NECK INSTITUTE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:NEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-593-1580
Mailing Address - Street 1:360 W BUTTERFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5025
Mailing Address - Country:US
Mailing Address - Phone:630-501-1706
Mailing Address - Fax:630-501-1704
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:630-501-1706
Practice Address - Fax:630-501-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103729261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical