Provider Demographics
NPI:1386201960
Name:ADVANCED PAIN AND SPINE INSTITUTE OF FLORIDA LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN AND SPINE INSTITUTE OF FLORIDA LLC
Other - Org Name:ADVANCED PAIN AND SPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARUQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-952-4422
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S STE 302A
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3117
Mailing Address - Country:US
Mailing Address - Phone:904-461-9330
Mailing Address - Fax:904-461-9330
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 302A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3117
Practice Address - Country:US
Practice Address - Phone:312-952-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME140144OtherMEDICAL LICENSE