Healthcare Provider Details

I. General information

NPI: 1215953815
Provider Name (Legal Business Name): MICHIGAN PAIN MANAGEMENT SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE LOWER LEVEL
LANSING MI
48912-1800
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5326
  • Fax: 517-364-5335
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007347
License Number StateMI

VIII. Authorized Official

Name: DR. CAMALA RIESSINGER
Title or Position: PRESIDENT
Credential: PHD
Phone: 517-364-5326