Healthcare Provider Details

I. General information

NPI: 1609984608
Provider Name (Legal Business Name): PAIN MANAGEMENT CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 WATER TOWER PL SUITE 220
CLARKSTON MI
48346-2671
US

IV. Provider business mailing address

1701 LAKE LANSING RD SUITE 100
LANSING MI
48912-3798
US

V. Phone/Fax

Practice location:
  • Phone: 248-620-4265
  • Fax: 248-620-4262
Mailing address:
  • Phone: 517-485-0001
  • Fax: 517-485-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHRAF I KHAN
Title or Position: OWNER
Credential: DO
Phone: 248-620-4265