Provider Demographics
NPI:1164833687
Name:INTERVENTIONAL PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:UJWALA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PURANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-476-7246
Mailing Address - Street 1:2211 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2748
Mailing Address - Country:US
Mailing Address - Phone:219-476-7246
Mailing Address - Fax:219-476-1713
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-4439
Practice Address - Country:US
Practice Address - Phone:219-476-7246
Practice Address - Fax:219-476-1713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERVENTIONAL PAIN MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical