Provider Demographics
NPI:1679858674
Name:METRO PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:METRO PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAGENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-480-5186
Mailing Address - Street 1:2720 S RIVER RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4106
Mailing Address - Country:US
Mailing Address - Phone:708-686-0040
Mailing Address - Fax:
Practice Address - Street 1:2720 S RIVER RD
Practice Address - Street 2:SUITE 218
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-4106
Practice Address - Country:US
Practice Address - Phone:708-686-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118798207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK48843Medicare UPIN