Great Lakes Pain & Treatment Centers, Ltd
Psychiatry & Neurology, Neurology in Lombard, IL. Organization (NPI-2).
NPI number1598916660
StatusActive
Last updated in NPPESOct 7, 2008
Details
- NPI
- 1598916660
- Entity type
- Organization (NPI-2)
- Legal business name
- Great Lakes Pain & Treatment Centers, Ltd
- Organization subpart
- No
- Enumeration date
- Oct 7, 2008
- Last updated
- Oct 7, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | 036-111890 | IL | Yes |
Practice location
2200 S Main StSuite 214
Lombard, IL 60148-5334
Phone 630-364-4114 · Fax 866-868-7320
Mailing address
2200 S Main StSuite 214
Lombard, IL 60148-5334
Phone 630-364-4114 · Fax 866-868-7320
Authorized official
Jonathan I Wang
President
6303644114
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