Healthcare Provider Details

I. General information

NPI: 1710022165
Provider Name (Legal Business Name): PAIN MANAGEMENT AND REHAB CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 3 MILE RD
GRAND RAPIDS MI
49544-8209
US

IV. Provider business mailing address

640 3 MILE RD
NORTH WEST GRAND RAPIDS MI
49544-8209
US

V. Phone/Fax

Practice location:
  • Phone: 313-381-8860
  • Fax: 313-381-0721
Mailing address:
  • Phone: 313-381-8860
  • Fax: 313-381-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MUZAFFAR AWAN
Title or Position: CEO
Credential: MD
Phone: 313-381-8860