Provider Demographics
NPI:1205090578
Name:HOLISTIC SCIENCE PAIN CLINIC LLC
Entity type:Organization
Organization Name:HOLISTIC SCIENCE PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:AKRAM
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-725-7200
Mailing Address - Street 1:105 129TH INFANTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-725-7200
Mailing Address - Fax:
Practice Address - Street 1:105 129TH INFANTRY DRIVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-725-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107324207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107324Medicaid
IL036107324Medicaid