Provider Demographics
NPI:1659786069
Name:POLPAIN INTERVENTIONAL PAIN MANAGEMENT CENTER LTD.
Entity Type:Organization
Organization Name:POLPAIN INTERVENTIONAL PAIN MANAGEMENT CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZBIGNIEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-307-0200
Mailing Address - Street 1:2090 GLADSTONE DR. UNIT B.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139
Mailing Address - Country:US
Mailing Address - Phone:630-307-0200
Mailing Address - Fax:312-377-1644
Practice Address - Street 1:2090 GLADSTONE DR.
Practice Address - Street 2:UNIT B
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139
Practice Address - Country:US
Practice Address - Phone:630-307-0200
Practice Address - Fax:312-377-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.130013261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center