Provider Demographics
NPI:1306489893
Name:UNIVERSAL PAIN MANAGEMENT INSTITUTE LTD
Entity type:Organization
Organization Name:UNIVERSAL PAIN MANAGEMENT INSTITUTE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-401-5341
Mailing Address - Street 1:461 BROWN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2463
Mailing Address - Country:US
Mailing Address - Phone:815-932-7242
Mailing Address - Fax:815-932-7307
Practice Address - Street 1:10 ORLAND SQUARE DR STE 10-C
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3207
Practice Address - Country:US
Practice Address - Phone:815-401-5341
Practice Address - Fax:708-942-6001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL PAIN MANAGEMENT INSTITUTE LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty