Provider Demographics
NPI:1952565384
Name:AAA HEADACHE AND PAIN CLINIC LTD
Entity Type:Organization
Organization Name:AAA HEADACHE AND PAIN CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-203-5795
Mailing Address - Street 1:1449 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1310
Mailing Address - Country:US
Mailing Address - Phone:916-203-5795
Mailing Address - Fax:
Practice Address - Street 1:1449 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1310
Practice Address - Country:US
Practice Address - Phone:916-203-5795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119222261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain