Healthcare Provider Details

I. General information

NPI: 1124782172
Provider Name (Legal Business Name): INTERVENTIONAL PAIN PROFESSIONALS WC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 KRAFT RD UNIT 280
NAPLES FL
34105-5098
US

IV. Provider business mailing address

3555 KRAFT RD UNIT 280
NAPLES FL
34105-5098
US

V. Phone/Fax

Practice location:
  • Phone: 239-367-7470
  • Fax:
Mailing address:
  • Phone: 239-367-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES PADULA
Title or Position: OWNER
Credential: DO
Phone: 239-367-7470