Provider Demographics
NPI:1225237571
Name:MINNESOTA INTERVENTIONAL PAIN ASSOCIATES
Entity Type:Organization
Organization Name:MINNESOTA INTERVENTIONAL PAIN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:JANIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-390-1279
Mailing Address - Street 1:12203 ABERDEEN ST NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5175
Mailing Address - Country:US
Mailing Address - Phone:763-390-1279
Mailing Address - Fax:763-390-1287
Practice Address - Street 1:11855 ULYSSES ST NE
Practice Address - Street 2:SUITE 240
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3947
Practice Address - Country:US
Practice Address - Phone:651-430-3800
Practice Address - Fax:651-430-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49158261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain