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General NPI Number Information
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NPI Number | 1578940417
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Entity Type | Organization
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Legal Business Name | LAFAYETTE PAIN CARE, P.C.
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 3728 SOUTH REED ROAD
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City | WILLIAMSPORT
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State | IN
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Zip | 47993-1049
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Country | US
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Telephone | 765-714-4344
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Fax | 765-838-3200
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Provider Business Mailing Address
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Address Line | 770 PARK EAST BLVD STE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-0786
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Country | US
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Telephone | 765-714-4344
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Fax | 765-838-3200
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Authorized Official
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Title or Position | OWNER
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Name | SHAZIA SIDDIQUI
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Credential | MD
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Telephone | 765-714-4344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | IN
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