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General NPI Number Information
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NPI Number | 1508996653
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Entity Type | Organization
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Legal Business Name | THE PAIN CENTER USA PLLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 27423 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-2867
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Country | US
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Telephone | 586-755-9855
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Fax | 586-755-9880
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Provider Business Mailing Address
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Address Line | 27423 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-2867
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Country | US
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Telephone | 586-755-9855
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Fax | 586-755-9880
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Authorized Official
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Title or Position | OWNER
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Name | RAJENDRA BOTHRA
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Credential | MD
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Telephone | 586-755-9855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 4301033013
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License Number State | MI
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