Great Lakes Pain & Treatment Centers, LTD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

036-111890 Issued in IL

Legal business name

GREAT LAKES PAIN & TREATMENT CENTERS, LTD

Practice address

2200 S Main St
Suite 214
Lombard, IL 60148-5334

Phone

(630) 364-4114

Fax

(866) 868-7320

NPI assigned

Oct 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jonathan I Wang, MD

Title

President

Phone

(630) 364-4114

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1598916660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 S MAIN ST",
            "address_2": "SUITE 214",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601485334",
            "telephone_number": "630-364-4114",
            "fax_number": "866-868-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 S MAIN ST",
            "address_2": "SUITE 214",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601485334",
            "telephone_number": "630-364-4114",
            "fax_number": "866-868-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PAIN & TREATMENT CENTERS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-364-4114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036-111890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irma Grantt
• Tazinika Gray
• J James Graziano, M.D.
• John A. Greager II, MD
• Great Lakes Living Solutions Corp.
• Jennifer Renee Green, DC, ND
• Casey Gregerson, CCC SLP
• Gregory Malo PSYD & Associates in Neuropsychology PC
• Trinity Griggs
• Catherine B. Grotelueschen, M.D.

• Neurology Physician in Lombard, IL
• Providers in Lombard, IL by specialty
• Neurology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.