Provider Demographics
NPI:1871903302
Name:IMMEDIATE PAIN CARE OF OAK BROOK
Entity type:Organization
Organization Name:IMMEDIATE PAIN CARE OF OAK BROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-560-4301
Mailing Address - Street 1:7641 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:630-560-4301
Mailing Address - Fax:
Practice Address - Street 1:2210 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1272
Practice Address - Country:US
Practice Address - Phone:630-560-4301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty