| Organization Name: | GREAT LAKE PAIN PHYSICIANS, LTD. |
| NPI Number: | 1023066420 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENDALL R. LUTZ (BILLING MANAGER) |
| Mailing Address: | 200 S Greenleaf St Suite A Gurnee |
| State: | IL US |
| Postal Code: | 600313398 |
| Phone Number: | 8472446464 |
| Fax Number: | |
| NPI Enumeration Date: | 05/05/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208VP0014X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pain Medicine |
| Taxonomy Specialization: | Interventional Pain Medicine |
| Taxonomy Definition: | Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |