Provider Demographics
NPI:1124376736
Name:ILLINOIS SPINE INSTITUTE,S.C.
Entity type:Organization
Organization Name:ILLINOIS SPINE INSTITUTE,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-519-9700
Mailing Address - Street 1:500 W GOLF RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3503
Mailing Address - Country:US
Mailing Address - Phone:847-519-9700
Mailing Address - Fax:847-519-9760
Practice Address - Street 1:415 E CONGRESS PKWY STE E
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6248
Practice Address - Country:US
Practice Address - Phone:847-519-9700
Practice Address - Fax:847-519-9760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILLINOIS SPINE INSTITUTE,S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211155Medicare UPIN