Basic Information
| Provider Information | |||||||||
| NPI: | 1952448417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN CLINIC OF MICHIGAN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 548 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480120548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486527520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5440 15 MILE RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483105111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869787250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KERKAR | ||||||||
| AuthorizedOfficialFirstName: | PRAMOD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2489787250 | ||||||||
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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 | 208VP0000X | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.