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GREAT LAKES PAIN MANAGEMENT MD PC NPI 1356419543


NPI Information

NPI: 1356419543
Provider Name: GREAT LAKES PAIN MANAGEMENT MD, PC
Classification: Pain Medicine - 208VP0014X
Entity Type: Organization

Specialization: Interventional Pain Medicine

CLIA Number: 23D2019550

Address:
1404 EUREKA AVE
WYANDOTTE, MI
ZIP 48192
Phone: (734) 282-4200
Get Directions

GREAT LAKES PAIN MANAGEMENT MD, PC is an interventional pain medicine pain medicine in Wyandotte, MI. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. GREAT LAKES PAIN MANAGEMENT MD, PC NPI is 1356419543. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1404 EUREKA AVE
WYANDOTTE, MI
ZIP 48192
Phone: (734) 282-4200
Fax: (734) 282-4210

The provider's authorized official is Mohamed L Othman .
The authorized official title is President and has the following contact phone number (734) 282-4200.

The CLIA number assigned to this NPI record is 23D2019550 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/4/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208VP0014XPain MedicineInterventional Pain MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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