Healthcare Provider Details

I. General information

NPI: 1376099390
Provider Name (Legal Business Name): INTERVENTIONAL PAIN & TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9079 KATY FWY SUITE C
HOUSTON TX
77024-1653
US

IV. Provider business mailing address

1000 JORIE BLVD SUITE 370
OAK BROOK IL
60523-2214
US

V. Phone/Fax

Practice location:
  • Phone: 630-417-4307
  • Fax:
Mailing address:
  • Phone: 630-417-4307
  • Fax:

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: ANITA SINGH
Title or Position: CEO
Credential:
Phone: 630-417-4307