MEDICARE: CHRONIC PAIN RELIEF, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1568971141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRONIC PAIN RELIEF, PA

Provider Business Mailing Address
First Line	:	PO BOX 494439
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75049-4439
Country	:	US
Telephone Number	:	214-304-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	3453 SAINT FRANCIS AVE STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6079
Country	:	US
Telephone Number	:	214-983-1787
Fax Number	:	214-292-9415

Authorized Official
Title or Position	:	OWNER
Name	:	BASEM AHMED ABDELFATTAH
Credential	:
Telephone Number	:	214-983-1787

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	12/15/2021

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