Provider Demographics
NPI:1629083290
Name:INTEGRATIVE PAIN MEDICINE SC
Entity Type:Organization
Organization Name:INTEGRATIVE PAIN MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-339-5300
Mailing Address - Street 1:80 W. HILLCREST BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195
Mailing Address - Country:US
Mailing Address - Phone:630-339-5300
Mailing Address - Fax:630-339-5305
Practice Address - Street 1:80 W. HILLCREST BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195
Practice Address - Country:US
Practice Address - Phone:630-339-5300
Practice Address - Fax:630-339-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106616207RR0500X
IL0360961792084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty