Provider Demographics
NPI:1750631479
Name:SPERO PAIN RELIEF THERAPY OF ILLINOIS, PC
Entity Type:Organization
Organization Name:SPERO PAIN RELIEF THERAPY OF ILLINOIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-363-5939
Mailing Address - Street 1:1105 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3512
Mailing Address - Country:US
Mailing Address - Phone:847-520-7111
Mailing Address - Fax:
Practice Address - Street 1:1105 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3512
Practice Address - Country:US
Practice Address - Phone:847-520-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain