Provider Demographics
NPI:1982823142
Name:UNIVERSITY PAIN CENTERS
Entity Type:Organization
Organization Name:UNIVERSITY PAIN CENTERS
Other - Org Name:UNIVERSITY PAIN CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PAIN CENTERS
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-942-3135
Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-3138
Mailing Address - Fax:
Practice Address - Street 1:3811 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1555
Practice Address - Country:US
Practice Address - Phone:630-852-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty