Provider Demographics
NPI:1821548215
Name:PROFESSIONAL ANESTHESIOLOGY INTERVENTIONAL NETWORK, INC
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIOLOGY INTERVENTIONAL NETWORK, INC
Other - Org Name:CHICAGO PAIN MANAGEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:EL BARIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-414-1088
Mailing Address - Street 1:1921 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1603
Mailing Address - Country:US
Mailing Address - Phone:312-414-1088
Mailing Address - Fax:855-343-3420
Practice Address - Street 1:1921 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1603
Practice Address - Country:US
Practice Address - Phone:312-414-1088
Practice Address - Fax:312-920-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134543207L00000X
MA261710207LP2900X
IN05005794A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN178 082 1264OtherNPI