Provider Demographics
NPI:1609273069
Name:PAIN MANAGEMENT CENTERS OF ILLINOIS SC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTERS OF ILLINOIS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-299-7000
Mailing Address - Street 1:8269 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1156
Mailing Address - Country:US
Mailing Address - Phone:847-299-7000
Mailing Address - Fax:847-299-7007
Practice Address - Street 1:8269 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1156
Practice Address - Country:US
Practice Address - Phone:847-299-7000
Practice Address - Fax:847-299-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.620378208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty