# INTERVENTIONAL SPINE AND PAIN CENTERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568642601
- **Authorized official:** DR. SHARIQ IBRAHIM MD (PHYSICIAN)
- **Authorized official phone:** (219) 513-2333

## Contact information

- **Practice address:** 8317 CALUMET AVE, SUITE A, MUNSTER, IN 46321-1737
- **Practice address phone:** (219) 513-2333
- **Practice address fax:** (219) 513-2334
- **Mailing address:** 8317 CALUMET AVE, SUITE A, MUNSTER, IN 46321-1737
- **Mailing address phone:** (219) 513-2333
- **Mailing address fax:** (219) 513-2334

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 01062605A | IN | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 01062605A | IN | Yes |

## Other

- **Enumeration date:** 11/06/2007
- **Last updated:** 04/20/2015