Provider Demographics
NPI:1255697058
Name:MIAMI INTERVENTIONAL PAIN AND REHABILITATION INC
Entity type:Organization
Organization Name:MIAMI INTERVENTIONAL PAIN AND REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SERPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-702-9441
Mailing Address - Street 1:748 SEVILLA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5628
Mailing Address - Country:US
Mailing Address - Phone:305-702-9441
Mailing Address - Fax:
Practice Address - Street 1:748 SEVILLA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5628
Practice Address - Country:US
Practice Address - Phone:305-702-9441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79847207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFEDERAL TAX ID