Healthcare Provider Details

I. General information

NPI: 1679763569
Provider Name (Legal Business Name): PAIN CONSULTANTS OF MICHIGAN, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 SOUTH WASHINGTON
SAGINAW MI
48601
US

IV. Provider business mailing address

1119 SOUTH WASHINGTON
SAGINAW MI
48601
US

V. Phone/Fax

Practice location:
  • Phone: 989-752-1900
  • Fax: 989-752-1901
Mailing address:
  • Phone: 989-752-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAKSHMANA MADALA
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 989-752-1900