Provider Demographics
NPI:1992923304
Name:RUSH NORTH SHORE PAIN CENTER
Entity type:Organization
Organization Name:RUSH NORTH SHORE PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAIN CENTER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-942-3135
Mailing Address - Street 1:9701 KNOX AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1256
Mailing Address - Country:US
Mailing Address - Phone:847-933-6974
Mailing Address - Fax:
Practice Address - Street 1:9701 KNOX AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1256
Practice Address - Country:US
Practice Address - Phone:847-933-6974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Not Answered207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL646410Medicare ID - Type UnspecifiedMEDICARE GROUP