Basic Information
| Provider Information | |||||||||
| NPI: | 1104013473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAY SPINE AND PAIN PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 REMINGTON BLVD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604403656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302261130 | ||||||||
| FaxNumber: | 6302261134 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 REMINGTON BLVD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604403656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302261130 | ||||||||
| FaxNumber: | 6302261134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | HONG | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6302261130 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.