Provider Demographics
NPI:1104620137
Name:INTEGRATED PAIN MANAGEMENT SC
Entity type:Organization
Organization Name:INTEGRATED PAIN MANAGEMENT SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-289-0999
Mailing Address - Street 1:244 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 WASHINGTON ST STE U
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5706
Practice Address - Country:US
Practice Address - Phone:630-629-6298
Practice Address - Fax:630-599-7149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED PAIN MANAGEMENT SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty