Provider Demographics
NPI:1689860975
Name:ILLINOIS CENTERS FOR PAIN AND REHAB, SC
Entity Type:Organization
Organization Name:ILLINOIS CENTERS FOR PAIN AND REHAB, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VOLKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:309-347-4277
Mailing Address - Street 1:3400 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6241
Mailing Address - Country:US
Mailing Address - Phone:309-347-4277
Mailing Address - Fax:
Practice Address - Street 1:3400 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6241
Practice Address - Country:US
Practice Address - Phone:309-347-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209498Medicare PIN
IL5075590001Medicare NSC