Provider Demographics
NPI:1184810749
Name:FIBROMYALGIA TREATMENT CENTER OF AMERICA
Entity type:Organization
Organization Name:FIBROMYALGIA TREATMENT CENTER OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-604-5321
Mailing Address - Street 1:4332 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2144
Mailing Address - Country:US
Mailing Address - Phone:773-604-5321
Mailing Address - Fax:773-604-5231
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:SUITE 3400 - DOCTOR OFFC BLDG 3
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-843-5742
Practice Address - Fax:847-490-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF83119Medicare UPIN