Healthcare Provider Details

I. General information

NPI: 1659683134
Provider Name (Legal Business Name): THE PAIN CENTER USA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22480 KELLY RD SUITE 100
EASTPOINTE MI
48021-2623
US

IV. Provider business mailing address

22480 KELLY RD SUITE 100
EASTPOINTE MI
48021-2623
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-7400
  • Fax: 586-776-8600
Mailing address:
  • Phone: 586-776-7400
  • Fax: 586-776-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJENDRA BOTHRA
Title or Position: OWNER
Credential: MD
Phone: 586-757-4000