Provider Demographics
NPI:1255510269
Name:ILLINOIS PAIN MANAGEMENT S C
Entity type:Organization
Organization Name:ILLINOIS PAIN MANAGEMENT S C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-912-1566
Mailing Address - Street 1:PO BOX 3307
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3307
Mailing Address - Country:US
Mailing Address - Phone:630-887-9233
Mailing Address - Fax:630-887-9234
Practice Address - Street 1:2315 E 93RD ST
Practice Address - Street 2:SUITE 237
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3936
Practice Address - Country:US
Practice Address - Phone:773-731-0500
Practice Address - Fax:312-277-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty