Provider Demographics
NPI:1922427632
Name:ELITE PAIN MANAGEMENT SC
Entity Type:Organization
Organization Name:ELITE PAIN MANAGEMENT SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORBEGOZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-704-1065
Mailing Address - Street 1:6894 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6967
Mailing Address - Country:US
Mailing Address - Phone:708-704-1065
Mailing Address - Fax:
Practice Address - Street 1:12337 S ROUTE 59
Practice Address - Street 2:SUITE 119
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-4625
Practice Address - Country:US
Practice Address - Phone:844-724-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097219207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH03724Medicare UPIN