Provider Demographics
NPI:1346738796
Name:ADVANCED PAIN MANAGEMENT AND ANESTHESIOLOGY
Entity type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT AND ANESTHESIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AALAEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-805-6854
Mailing Address - Street 1:4209 E BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5937
Mailing Address - Country:US
Mailing Address - Phone:219-805-6854
Mailing Address - Fax:
Practice Address - Street 1:4209 E. BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617
Practice Address - Country:US
Practice Address - Phone:219-805-6854
Practice Address - Fax:219-924-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134400.261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain