Provider Demographics
NPI:1861688418
Name:HORIZON INTERVENTIONAL PAIN PHYSICIANS, SC
Entity Type:Organization
Organization Name:HORIZON INTERVENTIONAL PAIN PHYSICIANS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:AWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-600-1134
Mailing Address - Street 1:7071 S 13TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1466
Mailing Address - Country:US
Mailing Address - Phone:414-600-1134
Mailing Address - Fax:414-455-4494
Practice Address - Street 1:7071 S 13TH ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1466
Practice Address - Country:US
Practice Address - Phone:414-600-1134
Practice Address - Fax:414-455-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34135500Medicaid
WIG96701Medicare UPIN