Provider Demographics
NPI:1942253075
Name:DANIEL L. BURKHEAD, MD LTD
Entity Type:Organization
Organization Name:DANIEL L. BURKHEAD, MD LTD
Other - Org Name:INNOVATIVE PAIN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
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:#110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7725
Mailing Address - Country:US
Mailing Address - Phone:702-316-2281
Mailing Address - Fax:702-316-2272
Practice Address - Street 1:9920 W CHEYENNE AVE
Practice Address - Street 2:#110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7725
Practice Address - Country:US
Practice Address - Phone:702-316-2281
Practice Address - Fax:702-316-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9100207LP2900X
207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG78072Medicare UPIN
V102687Medicare PIN