Provider Demographics
NPI:1528220175
Name:INTERVENTIONAL PAIN CONSULTANTS
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-384-6512
Mailing Address - Street 1:PO BOX 6899
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-6899
Mailing Address - Country:US
Mailing Address - Phone:847-809-3608
Mailing Address - Fax:847-685-0775
Practice Address - Street 1:1919 MIDWEST RD STE 201
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1318
Practice Address - Country:US
Practice Address - Phone:630-424-8240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL035082679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214263Medicare PIN