Healthcare Provider Details

I. General information

NPI: 1790881746
Provider Name (Legal Business Name): ADVANCED SPINE & PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 5 MILE RD SUITE 10
CINCINNATI OH
45230-4348
US

IV. Provider business mailing address

7691 5 MILE RD SUITE 10
CINCINNATI OH
45230-2163
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-7246
  • Fax: 513-624-6900
Mailing address:
  • Phone: 513-624-7246
  • Fax: 513-624-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number34.008823
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34.008823
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MUKARRAM ALI KHAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 513-624-7246