Organization
INTERVENTIONAL SPINE AND PAIN CENTERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARIQ IBRAHIM MD (PHYSICIAN)
(219) 513-2333
Entity
Organization
Contact information
Practice address
8317 CALUMET AVE, SUITE A, MUNSTER, IN 46321-1737
(219) 513-2333
(219) 513-2334
Mailing address
8317 CALUMET AVE, SUITE A, MUNSTER, IN 46321-1737
(219) 513-2333
(219) 513-2334
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01062605A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
01062605A
IN
Other
Enumeration date
11/06/2007
Last updated
04/20/2015
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