Provider Demographics
NPI:1699100859
Name:PAIN SPECIALISTS OF ILLINOIS, S.C
Entity type:Organization
Organization Name:PAIN SPECIALISTS OF ILLINOIS, S.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-571-1100
Mailing Address - Street 1:PO BOX 3307
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3307
Mailing Address - Country:US
Mailing Address - Phone:630-571-1100
Mailing Address - Fax:630-504-6265
Practice Address - Street 1:1925 E 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:630-571-1100
Practice Address - Fax:630-504-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty