MEDICARE: AMERICAN SPINE PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
2	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1982063038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN SPINE PC

Provider Business Mailing Address
First Line	:	PO BOX 3098
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90510-3098
Country	:	US
Telephone Number	:	310-792-3914
Fax Number	:	855-898-4055

Provider Business Practice Location Address
First Line	:	31571 CANYON ESTATES DR
Second Line	:	SUITE #115
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-0468
Country	:	US
Telephone Number	:	951-734-7246
Fax Number	:	877-694-3331

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KHURAM AKBAR SIAL
Credential	:	M.D.
Telephone Number	:	951-734-7246

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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Directions to “AMERICAN SPINE PC ” Practice Location

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