Healthcare Provider Details

I. General information

NPI: 1215563713
Provider Name (Legal Business Name): ELITE PAIN AND SPINE INSTITUTE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E MCKELLIPS RD STE 121
MESA AZ
85203-2527
US

IV. Provider business mailing address

1810 S CRISMON RD STE 188
MESA AZ
85209-3900
US

V. Phone/Fax

Practice location:
  • Phone: 480-900-7373
  • Fax: 480-900-6844
Mailing address:
  • Phone: 480-933-7373
  • Fax: 480-900-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ZEESHAN MALIK
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 702-374-2910