Provider Demographics
NPI:1053588079
Name:THE PAIN CENTER OF ILLINOIS INC.
Entity type:Organization
Organization Name:THE PAIN CENTER OF ILLINOIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:NEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-593-1580
Mailing Address - Street 1:2041 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8521
Mailing Address - Country:US
Mailing Address - Phone:312-624-8364
Mailing Address - Fax:
Practice Address - Street 1:2041 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8521
Practice Address - Country:US
Practice Address - Phone:312-624-8364
Practice Address - Fax:312-929-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-103729174400000X
207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty