=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497711733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METROPOLITAN PAIN MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4063 SALISBURY ROAD NORTH SUITE 206
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-296-3611
-----------------------------------------------------
Fax | 904-296-3617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4063 SALISBURY ROAD NORTH SUITE 206
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-296-3611
-----------------------------------------------------
Fax | 904-296-3617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ISMAIL DIRGHAM SALAHI
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 904-296-3611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | OS6845
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------