Provider Demographics
NPI:1831434430
Name:EQUINOX MEDICAL AND PAIN MANAGEMENT CENTER
Entity type:Organization
Organization Name:EQUINOX MEDICAL AND PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-705-7109
Mailing Address - Street 1:7900 N MILWAUKEE AVE STE 2-29
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3237
Mailing Address - Country:US
Mailing Address - Phone:708-705-7109
Mailing Address - Fax:708-788-1942
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 2-29
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3237
Practice Address - Country:US
Practice Address - Phone:708-705-7109
Practice Address - Fax:708-788-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108386208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty