Great Lake Pain Physicians LTD.

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

036-084312 Issued in IL

Legal business name

GREAT LAKE PAIN PHYSICIANS LTD.

Practice address

15 Tower CT
Ste # 190
Gurnee, IL 60031-3336

Phone

(847) 970-0885

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Eliza Diaconescu, M.D.

Title

Medical Director

Phone

(847) 970-0885

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1902016561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 TOWER CT",
            "address_2": "STE # 190",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313336",
            "telephone_number": "847-970-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 TOWER CT",
            "address_2": "STE # 190",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313336",
            "telephone_number": "847-970-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKE PAIN PHYSICIANS LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "DIACONESCU",
        "authorized_official_first_name": "ELIZA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "18479700885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IL",
            "license": "036-084312",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IL",
            "license": "036-084312",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "IL",
            "license": "036-084312",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036-084312",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerard Martin Goshgarian, M.D.
• Kathy Gouzoules, RN
• Brittney Graboys, PSYD
• Andrea M Grant, OTR/L
• Robert Andrew Grasso Jr., PHARM.D.
• Great Lake Pain Physicians, LTD.
• Daniel Joseph Green, M.D.
• Rachael A Greenberg, M.D.
• Abigail K Greene
• Greenleaf Orthopaedic Associates, S.C.

• Pain Medicine (Anesthesiology) Physician in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Pain Medicine (Anesthesiology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; 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.