Healthcare Provider Details

I. General information

NPI: 1386201960
Provider Name (Legal Business Name): ADVANCED PAIN AND SPINE INSTITUTE OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 302A
ST AUGUSTINE FL
32080-3117
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 302A
ST AUGUSTINE FL
32080-3117
US

V. Phone/Fax

Practice location:
  • Phone: 312-952-4422
  • Fax:
Mailing address:
  • Phone: 904-461-9330
  • Fax: 904-461-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ADNAN FARUQI
Title or Position: OWNER
Credential: MD
Phone: 312-952-4422