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General NPI Number Information
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NPI Number | 1801347398
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Entity Type | Organization
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Legal Business Name | ST CLAIR PAIN CONSULTANTS PC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 29751 LITTLE MACK AVE SUITE A
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City | ROSEVILLE
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State | MI
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Zip | 48066-6503
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Country | US
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Telephone | 313-580-0015
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Fax | 313-884-6313
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Provider Business Mailing Address
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Address Line | 432 S WASHINGTON AVE UNIT 1101
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City | ROYAL OAK
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State | MI
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Zip | 48067-3854
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Country | US
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Telephone | 313-580-0015
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Fax | 313-884-6313
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN G GHANEM
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Credential | M.D.
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Telephone | 313-580-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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