Healthcare Provider Details

I. General information

NPI: 1952667859
Provider Name (Legal Business Name): PAIN PHYSICIANS OF INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8687 CONNECTICUT ST STE D
MERRILLVILLE IN
46410-5541
US

IV. Provider business mailing address

PO BOX 10685
MERRILLVILLE IN
46411-0685
US

V. Phone/Fax

Practice location:
  • Phone: 219-750-9630
  • Fax: 219-750-9451
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TAREK HASSAN SHAHBANDAR
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 219-750-9630