NPIMap

Organization Active NPI

Interventional Pain & Anesthesia Consultants PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Dearborn, MI
National Provider Identifier
1164877692
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
5101017919 Issued in MI
Legal business name
INTERVENTIONAL PAIN & ANESTHESIA CONSULTANTS PLLC
Practice address
20100 Outer Dr
Dearborn, MI 48124-2647
Phone
(734) 604-0017
NPI assigned
May 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bryant T Ittiara, D.O.NPI 1871829069
Title
President
Phone
(734) 604-0017

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 5101017919 MI Primary

Addresses

Primary practice location

20100 Outer Dr
Dearborn, MI 48124-2647

Mailing address

416 James Cir
Royal Oak, MI 48067-4545
Phone (734) 604-0017

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1164877692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 JAMES CIR",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480674545",
            "telephone_number": "734-604-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20100 OUTER DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242647",
            "telephone_number": "734-604-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN & ANESTHESIA CONSULTANTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-03",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "ITTIARA",
        "authorized_official_first_name": "BRYANT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-604-0017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MI",
            "license": "5101017919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.