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General NPI Number Information
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NPI Number | 1952438038
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT OF BRANDON, INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 204 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5707
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Country | US
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Telephone | 813-651-0052
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Fax | 813-661-0000
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Provider Business Mailing Address
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Address Line | 204 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5707
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Country | US
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Telephone | 813-651-0052
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Fax | 813-661-0000
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DENISE STANKIEWICZ
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Credential |
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Telephone | 813-652-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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