Provider Demographics
NPI:1962546291
Name:PAIN MANAGEMENT INSTITUTE OF FLORIDA PA
Entity type:Organization
Organization Name:PAIN MANAGEMENT INSTITUTE OF FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:RAFIK
Authorized Official - Last Name:KHALAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-778-8882
Mailing Address - Street 1:1936 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2573
Mailing Address - Country:US
Mailing Address - Phone:772-778-8882
Mailing Address - Fax:772-778-8894
Practice Address - Street 1:1936 32ND AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2573
Practice Address - Country:US
Practice Address - Phone:772-778-8882
Practice Address - Fax:772-778-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87468208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03527OtherBCBS
FLK8234Medicare UPIN