Provider Demographics
NPI:1558789628
Name:DANIEL L. BURKHEAD, M.D. LTD
Entity Type:Organization
Organization Name:DANIEL L. BURKHEAD, M.D. LTD
Other - Org Name:INNOVATIVE PAIN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-316-2281
Mailing Address - Street 1:9920 W. CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129
Mailing Address - Country:US
Mailing Address - Phone:702-316-2281
Mailing Address - Fax:702-316-2272
Practice Address - Street 1:501 S. RANCHO DR.
Practice Address - Street 2:SUITE G-44
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-316-2281
Practice Address - Fax:702-316-2272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL L. BURKHEAD, M.D. LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102687Medicare UPIN