Unknown Individual – Pain Medicine (Anesthesiology) Physician, NPI 1417074451

Pain Medicine (Anesthesiology) Physician

Unknown Individual is a healthcare provider. based in Pembroke pines, Florida. specializing in Pain Medicine (Anesthesiology) Physician. They hold a License No. 0039044 (FL). The NPI Number for Unknown Individual is 1417074451

Main info

Organization

Inactive

Name

Unknown Individual

NPI

1417074451

Phone

(954) 963-6038

Address

1821 NW 72ND WAY

Deactivation Date

18 December 2020

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

1821 NW 72ND WAY
PEMBROKE PINES, FL 330241039
Phone: (954) 963-6038
Fax: (954) 963-6038
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33024)

Loading plans...

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Does Unknown Individual share an NPI with anyone else?

NPI numbers are unique to each provider or organization — Unknown Individual uses 1417074451.

Why might Unknown Individual appear inactive while still practicing?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Pain Medicine (Anesthesiology) Physician in this dataset. Clinical services aligned with this taxonomy classification.

What address line appears for Unknown Individual?

Unknown Individual's geographic hint is Pembroke Pines, Florida in our summary view.

Is the information about Unknown Individual up to date?

Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."