Provider Demographics
NPI:1710028428
Name:ILLINOIS SPINE INSTITUTE,S.C.
Entity Type:Organization
Organization Name:ILLINOIS SPINE INSTITUTE,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-303-1200
Mailing Address - Street 1:500 W GOLF RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3503
Mailing Address - Country:US
Mailing Address - Phone:847-303-1200
Mailing Address - Fax:
Practice Address - Street 1:500 W GOLF RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3503
Practice Address - Country:US
Practice Address - Phone:847-303-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID NUMBER
IL211155Medicare ID - Type Unspecified