Healthcare Provider Details

I. General information

NPI: 1427615335
Provider Name (Legal Business Name): PAIN PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 GRIFFIN RD
DAVIE FL
33314-4341
US

IV. Provider business mailing address

453 SW 169TH TER
WESTON FL
33326-1530
US

V. Phone/Fax

Practice location:
  • Phone: 954-900-3163
  • Fax:
Mailing address:
  • Phone: 954-300-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN KOWALSKI
Title or Position: OWNER
Credential: DO, MBA
Phone: 954-300-7688