Provider Demographics
NPI:1154374767
Name:PAIN MANAGEMENT INSTITUTE CORP
Entity type:Organization
Organization Name:PAIN MANAGEMENT INSTITUTE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-464-7212
Mailing Address - Street 1:4985 DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-5314
Mailing Address - Country:US
Mailing Address - Phone:815-464-7212
Mailing Address - Fax:
Practice Address - Street 1:10181 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1274
Practice Address - Country:US
Practice Address - Phone:815-464-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090578208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0163014OtherBLUE CROSS
IL036090578Medicaid
ILP00025045OtherRR MEDICARE
IL214228Medicare PIN
IL0163014OtherBLUE CROSS
IL210736Medicare ID - Type UnspecifiedWILL COUNTY
IL036090578Medicaid