Provider Demographics
NPI:1083051346
Name:INTERVENTIONAL PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PURANIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-326-7246
Mailing Address - Street 1:2205 ROOSEVELT ROAD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-476-7246
Mailing Address - Fax:219-476-1713
Practice Address - Street 1:2205 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2748
Practice Address - Country:US
Practice Address - Phone:219-476-7246
Practice Address - Fax:219-476-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical