Provider Demographics
NPI:1609169945
Name:ILLINOIS ANESTHESIA AND PAIN ASSOCIATES SC
Entity Type:Organization
Organization Name:ILLINOIS ANESTHESIA AND PAIN ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-726-2368
Mailing Address - Street 1:1301 COPPERFIELD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2056
Mailing Address - Country:US
Mailing Address - Phone:708-479-6522
Mailing Address - Fax:708-286-6461
Practice Address - Street 1:11634 QUARTZ CT
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9028
Practice Address - Country:US
Practice Address - Phone:708-479-6522
Practice Address - Fax:708-286-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100713207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100713Medicaid