Provider Demographics
NPI:1700179629
Name:CENTER FOR ADVANCED SPINE TECHNOLOGIES INC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED SPINE TECHNOLOGIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABUBAKAR
Authorized Official - Middle Name:ATIQ
Authorized Official - Last Name:DURRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-327-2278
Mailing Address - Street 1:4555 LAKE FOREST AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3781
Mailing Address - Country:US
Mailing Address - Phone:877-327-2278
Mailing Address - Fax:888-322-2278
Practice Address - Street 1:8075 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2693
Practice Address - Country:US
Practice Address - Phone:877-327-2278
Practice Address - Fax:888-322-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100048813Medicare PIN