Provider Demographics
NPI:1851404131
Name:RX PAIN MANAGEMENT
Entity Type:Organization
Organization Name:RX PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DALMACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-247-2131
Mailing Address - Street 1:229 W 25TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2220
Mailing Address - Country:US
Mailing Address - Phone:773-247-2131
Mailing Address - Fax:773-247-3110
Practice Address - Street 1:736 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4484
Practice Address - Country:US
Practice Address - Phone:773-247-2131
Practice Address - Fax:773-247-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1620404OtherBCBS
ILK04746Medicare PIN
ILD13110Medicare UPIN
IL1620404OtherBCBS