Healthcare Provider Details

I. General information

NPI: 1861108334
Provider Name (Legal Business Name): ADVANCED PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 DUNLAWTON AVE STE 103
PORT ORANGE FL
32127-4252
US

IV. Provider business mailing address

27810 SUMMERGATE BLVD
WESLEY CHAPEL FL
33544-6919
US

V. Phone/Fax

Practice location:
  • Phone: 386-671-0600
  • Fax: 386-756-2511
Mailing address:
  • Phone: 813-388-2948
  • Fax: 813-388-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MAULIK K BHALANI
Title or Position: OWNER/ PROVIDER
Credential: MD
Phone: 813-388-2948