Healthcare Provider Details

I. General information

NPI: 1487664041
Provider Name (Legal Business Name): INTERNATIONAL CENTER FOR PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLACKWOOD AVE SUITE 150
OCOEE FL
34761-4519
US

IV. Provider business mailing address

PO BOX 1507
WINDERMERE FL
34786-1507
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1902
  • Fax: 407-358-5366
Mailing address:
  • Phone: 407-296-1902
  • Fax: 407-358-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME83805
License Number StateFL

VIII. Authorized Official

Name: DR. MUHAMMAD HASSAN SALEM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-296-1902