Provider Demographics
NPI:1477919686
Name:ASCLEPIUS PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:ASCLEPIUS PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKOVCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-221-2582
Mailing Address - Street 1:PO BOX 836156
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-6156
Mailing Address - Country:US
Mailing Address - Phone:214-974-8990
Mailing Address - Fax:
Practice Address - Street 1:7920 BELT LINE RD
Practice Address - Street 2:120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8145
Practice Address - Country:US
Practice Address - Phone:214-221-2582
Practice Address - Fax:214-446-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4020208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty