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General NPI Number Information
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NPI Number | 1235687666
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Entity Type | Organization
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Legal Business Name | GREEN SURGICAL, LLC.
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 8687 CONNECTICUT ST SUITE D
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6361
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Country | US
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Telephone | 219-750-9630
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10713
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City | MERRILLVILLE
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State | IN
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Zip | 46411
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Country | US
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Telephone | 219-750-9630
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAREK SHAHBANDAR
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Credential | M.D.
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Telephone | 219-750-9630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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