Healthcare Provider Details

I. General information

NPI: 1356536064
Provider Name (Legal Business Name): PAIN AND REHABILITATION PHYSICIANS. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26333 SOUTHFIELD RD
LATHRUP VILLAGE MI
48076-4574
US

IV. Provider business mailing address

26333 SOUTHFIELD RD
LATHRUP VILLAGE MI
48076-4574
US

V. Phone/Fax

Practice location:
  • Phone: 248-331-1900
  • Fax:
Mailing address:
  • Phone: 248-331-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301062397
License Number StateMI

VIII. Authorized Official

Name: DR. ABIOLA DIANNE OBAYAN
Title or Position: CEO/MEDICAL DIRECTOR
Credential: MD
Phone: 248-331-1900