MEDICARE: INNOVATIVE PAIN AND WELLNESS PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	208VP0000X	Pain Medicine Physician
3	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1205494440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE PAIN AND WELLNESS PLC

Provider Business Mailing Address
First Line	:	18511 N SCOTTSDALE RD STE 202
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-9694
Country	:	US
Telephone Number	:	480-306-7242
Fax Number	:

Provider Business Practice Location Address
First Line	:	22601 N 19TH AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-1324
Country	:	US
Telephone Number	:	623-231-2443
Fax Number	:

Authorized Official
Title or Position	:	OWNER, MD
Name	:	DANIEL KARL OCONNOR
Credential	:
Telephone Number	:	480-306-7242

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	03/09/2020

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