Provider Demographics
NPI:1801146303
Name:CHICAGOLAND PAIN MANAGEMENT INSTITUTE, INC.
Entity type:Organization
Organization Name:CHICAGOLAND PAIN MANAGEMENT INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUBIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-312-4562
Mailing Address - Street 1:420 S. SCHMIDT ROAD
Mailing Address - Street 2:STE. 110
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1737
Mailing Address - Country:US
Mailing Address - Phone:630-312-4562
Mailing Address - Fax:630-312-6651
Practice Address - Street 1:420 S. SCHMIDT ROAD
Practice Address - Street 2:STE. 240
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2634
Practice Address - Country:US
Practice Address - Phone:630-312-4562
Practice Address - Fax:630-312-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
IL208VP0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty