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Organization

ADVANCED SPINE & PAIN MANAGEMENT INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MUKARRAM ALI KHAN D.O. (PRESIDENT)
(513) 624-7246
Entity
Organization

Contact information

Practice address
7691 5 MILE RD, SUITE 10, CINCINNATI, OH 45230-4348
(513) 624-7246
(513) 624-6900
Mailing address
7691 5 MILE RD, SUITE 10, CINCINNATI, OH 45230-2163
(513) 624-7246
(513) 624-6900

Taxonomy

Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
34.008823
OH
208VP0014X
Interventional Pain Medicine Physician
Primary
34.008823
OH
332B00000X
Durable Medical Equipment & Medical Supplies
OH
363LA2200X
Adult Health Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000488997
ANTHEM
OH
01
150730
NATIONWIDE
OH
05
2679703
OH
01
296827989001
MEDICAL MUTUAL
01
317306
AMERIGROUP
OH
01
617433400
DEPT OF LABOR - MD
OH
01
617433403
US DEPT OF LABOR - SPRINGFIELD OFFICE
OH
01
617433404
US DEPT OF LABOR - EATON OFFICE
OH
01
617433406
US DEPT OF LABOR - SPRINGBORO OFFICE
OH
01
617465100
DEPT. OF LABOR - APRN
OH
01
6226080
CIGNA
OH
05
7100240230 MD GRP #
OH
05
7100287020 -NP GROUP
KY
05
7100315340 - MD GRP
KY
01
P00415701
RAILROAD MEDICARE
OH
Enumeration date
09/16/2006
Last updated
06/28/2016
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