Healthcare Provider Details

I. General information

NPI: 1689954950
Provider Name (Legal Business Name): DEAN PAIN MANAGEMENT SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 12/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 CASPER CT
MOUNT PLEASANT WI
53406-5811
US

IV. Provider business mailing address

6520 CASPER CT
MOUNT PLEASANT WI
53406-5811
US

V. Phone/Fax

Practice location:
  • Phone: 262-488-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateWI

VIII. Authorized Official

Name: DR. SAMMY DEAN
Title or Position: PRESIDENT
Credential:
Phone: 815-943-8090