Basic Information
| Provider Information | |||||||||
| NPI: | 1164793683 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 BOWERS ST | ||||||||
| Address2: | UNIT 2365 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480127107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376733983 | ||||||||
| FaxNumber: | 9897900261 | ||||||||
| Practice Location | |||||||||
| Address1: | 4677 TOWNE CENTRE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376733983 | ||||||||
| FaxNumber: | 9877900261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2012 | ||||||||
| LastUpdateDate: | 08/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | AHSAN | ||||||||
| AuthorizedOfficialFirstName: | MUHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | KAMRAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9376733983 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 4301097463 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.