Provider Demographics
NPI:1477974574
Name:INTEGRATED PAIN MANAGEMENT (BERWYN) LTD
Entity Type:Organization
Organization Name:INTEGRATED PAIN MANAGEMENT (BERWYN) LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:XIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-235-8000
Mailing Address - Street 1:3253 HARLEM AVE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2996
Mailing Address - Country:US
Mailing Address - Phone:773-235-8000
Mailing Address - Fax:773-235-7018
Practice Address - Street 1:3253 HARLEM AVE
Practice Address - Street 2:UNIT 5
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2996
Practice Address - Country:US
Practice Address - Phone:630-629-6298
Practice Address - Fax:630-495-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty