Provider Demographics
NPI:1891726345
Name:INTERVENTIONAL PAIN MANAGEMENT, LTD.
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN MANAGEMENT, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLACHEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-895-9450
Mailing Address - Street 1:18221 TORRENCE AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2870
Mailing Address - Country:US
Mailing Address - Phone:708-895-9450
Mailing Address - Fax:708-895-9455
Practice Address - Street 1:18221 TORRENCE AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2870
Practice Address - Country:US
Practice Address - Phone:708-895-9450
Practice Address - Fax:708-895-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty