Provider Demographics
NPI:1053425454
Name:PAIN THERAPY ASSOCIATES LTD.
Entity type:Organization
Organization Name:PAIN THERAPY ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAJDE
Authorized Official - Middle Name:
Authorized Official - Last Name:DABAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-352-5511
Mailing Address - Street 1:3200 W HIGGINS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2174
Mailing Address - Country:US
Mailing Address - Phone:847-352-5511
Mailing Address - Fax:847-352-5585
Practice Address - Street 1:3200 W HIGGINS RD STE 101
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2174
Practice Address - Country:US
Practice Address - Phone:847-352-5511
Practice Address - Fax:847-352-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
214399Medicare PIN