MEDICARE: PAIN CLINIC OF MICHIGAN PC

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		MI

General Provider Information

NPI Number	:	1952448417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN CLINIC OF MICHIGAN PC

Provider Business Mailing Address
First Line	:	PO BOX 548
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48012-0548
Country	:	US
Telephone Number	:	248-652-7520
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5111
Country	:	US
Telephone Number	:	586-978-7250
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRAMOD KERKAR
Credential	:	MD
Telephone Number	:	248-978-7250

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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