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General NPI Number Information
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NPI Number | 1164687778
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Entity Type | Organization
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Legal Business Name | FLORIDA INTERVENTIONAL PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 1447 MEDICAL PARK BLVD 209
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City | WELLINGTON
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State | FL
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Zip | 33414-3164
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Country | US
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Telephone | 561-537-4817
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Fax |
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Provider Business Mailing Address
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Address Line | 1447 MEDICAL PARK BLVD 209
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City | WELLINGTON
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State | FL
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Zip | 33414-3483
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Country | US
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Telephone | 561-537-4817
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAULIS MARIUS BANIONIS
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Credential | M.D.
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Telephone | 561-537-4817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME98566
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License Number State | FL
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