Healthcare Provider Details

I. General information

NPI: 1366017527
Provider Name (Legal Business Name): INTEGRATED PAIN CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 109
MESA AZ
85206-4671
US

IV. Provider business mailing address

9500 E IRONWOOD SQUARE DR
SCOTTSDALE AZ
85258-4582
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-2552
  • Fax:
Mailing address:
  • Phone: 480-626-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NIKESH SETH
Title or Position: CEO
Credential: MD
Phone: 480-626-2552