Provider Demographics
NPI:1306274097
Name:INTERVENTIONAL PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:UJWALA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PURANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-391-3994
Mailing Address - Street 1:208 LEGACY PLZ W
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-5285
Mailing Address - Country:US
Mailing Address - Phone:219-326-7246
Mailing Address - Fax:219-326-7234
Practice Address - Street 1:208 LEGACY PLZ W
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5285
Practice Address - Country:US
Practice Address - Phone:219-326-7246
Practice Address - Fax:219-326-7234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERVENTIONAL PAIN MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-16
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical