Healthcare Provider Details

I. General information

NPI: 1124702287
Provider Name (Legal Business Name): ADVANCE PAIN & ANESTHESIA CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 HICKORY RD STE B
MISHAWAKA IN
46545-8863
US

IV. Provider business mailing address

11456 S. BROADWAY
CROWN POINT IN
46307-7106
US

V. Phone/Fax

Practice location:
  • Phone: 574-251-0498
  • Fax: 574-251-0068
Mailing address:
  • Phone: 219-488-0154
  • Fax: 219-661-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHEEL PATEL
Title or Position: CMO
Credential: MD
Phone: 219-575-7578