Healthcare Provider Details

I. General information

NPI: 1063257830
Provider Name (Legal Business Name): 1488 PAINMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3786 FM 1488 RD STE 120
CONROE TX
77384-4986
US

IV. Provider business mailing address

400 STONEBROOK PKWY STE 1104-174
FRISCO TX
75036-1179
US

V. Phone/Fax

Practice location:
  • Phone: 214-390-7697
  • Fax: 972-432-6692
Mailing address:
  • Phone: 214-390-7697
  • Fax: 972-432-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ADNAN SHAIKH
Title or Position: ADMIN
Credential:
Phone: 214-415-6845