Provider Demographics
NPI:1972883387
Name:QUALITY PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:QUALITY PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST & PAIN PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HUMAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-930-2067
Mailing Address - Street 1:2304 DUNMORE DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-8453
Mailing Address - Country:US
Mailing Address - Phone:630-930-2067
Mailing Address - Fax:
Practice Address - Street 1:8190 CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5013
Practice Address - Country:US
Practice Address - Phone:630-333-0501
Practice Address - Fax:630-541-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095004261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6387Medicare PIN