Organization
ADVANCED INTERVENTIONAL PAIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATTANAM DORAI SRINIVASAN MD (CEO)
(765) 891-0721
Entity
Organization
Contact information
Practice address
613 W LINCOLN RD STE A, KOKOMO, IN 46902-3460
(765) 319-3522
(765) 450-6161
Mailing address
2001 N GRANVILLE AVE, MUNCIE, IN 47303-2110
(765) 284-0493
(765) 284-2434
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200532650A
—
IN
Enumeration date
07/14/2006
Last updated
07/04/2020
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