Basic Information
| Provider Information | |||||||||
| NPI: | 1255743738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PAIN SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 674809 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482674809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342123097 | ||||||||
| FaxNumber: | 7342123114 | ||||||||
| Practice Location | |||||||||
| Address1: | 18100 OAKWOOD BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139297246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2014 | ||||||||
| LastUpdateDate: | 07/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | BORREGO | ||||||||
| AuthorizedOfficialFirstName: | RICARDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3133008682 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.