Provider Demographics
NPI:1629373774
Name:MILLENNIUM PAIN CENTER OF LAKE COUNTY
Entity Type:Organization
Organization Name:MILLENNIUM PAIN CENTER OF LAKE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENYAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-662-4321
Mailing Address - Street 1:5198 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0051
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:847-615-2858
Practice Address - Street 1:1880 W WINCHESTER RD
Practice Address - Street 2:#101
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5341
Practice Address - Country:US
Practice Address - Phone:847-281-9543
Practice Address - Fax:847-281-9615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLENNIUM PAIN CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-21
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain