Healthcare Provider Details

I. General information

NPI: 1750249819
Provider Name (Legal Business Name): INJURY PAIN MD & AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 TAMIAMI TRL S UNIT 402
VENICE FL
34285-5563
US

IV. Provider business mailing address

1505 TAMIAMI TRL S UNIT 402
VENICE FL
34285-5563
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-8762
  • Fax: 941-444-8762
Mailing address:
  • Phone: 941-444-8762
  • Fax: 941-444-8762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANJU MADNANI
Title or Position: DIRECTOR
Credential: MD
Phone: 215-539-0844