Provider Demographics
NPI:1801964473
Name:PAIN CENTERS OF CHICAGO LLC
Entity type:Organization
Organization Name:PAIN CENTERS OF CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-945-3000
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499
Mailing Address - Country:US
Mailing Address - Phone:815-729-0450
Mailing Address - Fax:815-729-0459
Practice Address - Street 1:1305 WALT WHITMAN RD STE 300
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4300
Practice Address - Country:US
Practice Address - Phone:516-945-3000
Practice Address - Fax:815-729-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211125Medicare ID - Type UnspecifiedMEDICARE GROUP #