Provider Demographics
NPI:1497711733
Name:METROPOLITAN PAIN MANAGEMENT
Entity Type:Organization
Organization Name:METROPOLITAN PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:DIRGHAM
Authorized Official - Last Name:SALAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-296-3611
Mailing Address - Street 1:4063 SALISBURY ROAD NORTH
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-296-3611
Mailing Address - Fax:904-296-3617
Practice Address - Street 1:4063 SALISBURY ROAD NORTH
Practice Address - Street 2:SUITE 206
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-296-3611
Practice Address - Fax:904-296-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6845207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS6845OtherWORKERS COMPENSATION
FL5121707OtherAETNA
FL271598OtherAVMED
GA52667803002OtherBCBS OF GEORGIA
FL5121707OtherAETNA
FL57441YMedicare ID - Type Unspecified
FL=========OtherHUMANA