Healthcare Provider Details

I. General information

NPI: 1801349386
Provider Name (Legal Business Name): INTERVENTIONAL PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 45TH STREET
MUNSTER IN
46321
US

IV. Provider business mailing address

2105 ROOSEVELT RD
VALPARAISO IN
46383-2907
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-7246
  • Fax: 219-476-1713
Mailing address:
  • Phone: 219-476-7246
  • Fax: 219-476-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: UJWALA PURANIK
Title or Position: COO
Credential:
Phone: 219-476-7246