Provider Demographics
NPI:1548970478
Name:LAFAYETTE PAIN CARE PC
Entity type:Organization
Organization Name:LAFAYETTE PAIN CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:MERAJ
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-714-4344
Mailing Address - Street 1:PO BOX 5748
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5748
Mailing Address - Country:US
Mailing Address - Phone:765-714-4344
Mailing Address - Fax:
Practice Address - Street 1:1714 DIVIDEND DR
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1572
Practice Address - Country:US
Practice Address - Phone:765-714-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty