Provider Demographics
NPI:1699944918
Name:CHICAGO PAIN & REHAB CENTER, INC
Entity type:Organization
Organization Name:CHICAGO PAIN & REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDVEKHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-530-9317
Mailing Address - Street 1:844 SWALLOW ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3651
Mailing Address - Country:US
Mailing Address - Phone:847-530-9317
Mailing Address - Fax:847-541-3316
Practice Address - Street 1:844 SWALLOW ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3651
Practice Address - Country:US
Practice Address - Phone:847-530-9317
Practice Address - Fax:847-541-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK 35244Medicare PIN