Provider Demographics
NPI:1740686658
Name:AMERICAN PAIN INSTITUTE INC
Entity type:Organization
Organization Name:AMERICAN PAIN INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-226-4556
Mailing Address - Street 1:1753 W CHICAGO AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5009
Mailing Address - Country:US
Mailing Address - Phone:312-226-4556
Mailing Address - Fax:312-226-3775
Practice Address - Street 1:1753 W CHICAGO AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5009
Practice Address - Country:US
Practice Address - Phone:312-226-4556
Practice Address - Fax:312-226-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty