Provider Demographics
NPI:1437556941
Name:ILLINOIS CENTER FOR PAIN CONTROL LLC
Entity Type:Organization
Organization Name:ILLINOIS CENTER FOR PAIN CONTROL LLC
Other - Org Name:THE VANGUARD MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:M
Authorized Official - Last Name:QUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-809-9839
Mailing Address - Street 1:10176 W 400 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9008
Mailing Address - Country:US
Mailing Address - Phone:219-809-9839
Mailing Address - Fax:219-809-9841
Practice Address - Street 1:10176 W 400 N
Practice Address - Street 2:SUITE B
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9008
Practice Address - Country:US
Practice Address - Phone:219-809-9839
Practice Address - Fax:219-809-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty