MEDICARE: PAIN MANAGEMENT MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ592332Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1932139821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT MEDICAL CENTER

Provider Business Mailing Address
First Line	:	3545 LONG BEACH BLVD
Second Line	:	SUITE 105
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3941
Country	:	US
Telephone Number	:	562-595-0060
Fax Number	:	562-981-0916

Provider Business Practice Location Address
First Line	:	3545 LONG BEACH BLVD
Second Line	:	SUITE 105
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3941
Country	:	US
Telephone Number	:	562-595-0060
Fax Number	:	562-981-0916

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MEDHAT FOUAD MIKHAEL
Credential	:	M.D.
Telephone Number	:	562-595-0060

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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Directions to “PAIN MANAGEMENT MEDICAL CENTER ” Practice Location

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