Provider Demographics
NPI:1801782057
Name:THE HEADACHE LAB
Entity type:Organization
Organization Name:THE HEADACHE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-423-8150
Mailing Address - Street 1:9760 S KEDZIE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3182
Mailing Address - Country:US
Mailing Address - Phone:708-942-6869
Mailing Address - Fax:
Practice Address - Street 1:9760 S KEDZIE AVE STE 2
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3182
Practice Address - Country:US
Practice Address - Phone:708-942-6869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK PRIMARY CARE, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty