Provider Demographics
NPI:1770109142
Name:ILLINOIS PAIN AND NEUROPATHY CENTER LTD
Entity type:Organization
Organization Name:ILLINOIS PAIN AND NEUROPATHY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORZLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-257-0550
Mailing Address - Street 1:1192 WALTER ST STE C
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-2905
Mailing Address - Country:US
Mailing Address - Phone:630-257-0550
Mailing Address - Fax:630-257-0555
Practice Address - Street 1:1192 WALTER ST STE C
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2905
Practice Address - Country:US
Practice Address - Phone:630-257-0550
Practice Address - Fax:630-257-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty