Provider Demographics
NPI:1831435544
Name:PAIN TREATMENT CENTER OF CHICAGO
Entity type:Organization
Organization Name:PAIN TREATMENT CENTER OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJJO-RIFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-772-8876
Mailing Address - Street 1:2004 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-3767
Mailing Address - Country:US
Mailing Address - Phone:773-772-8876
Mailing Address - Fax:773-252-3091
Practice Address - Street 1:2004 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3767
Practice Address - Country:US
Practice Address - Phone:773-772-8876
Practice Address - Fax:773-252-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087128208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty