Provider Demographics
NPI:1073108643
Name:PAIN AND SPINE RECOVERY PLLC
Entity Type:Organization
Organization Name:PAIN AND SPINE RECOVERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ABID
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-525-8697
Mailing Address - Street 1:27644 HARTWICK CIR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-4002
Mailing Address - Country:US
Mailing Address - Phone:248-525-8697
Mailing Address - Fax:
Practice Address - Street 1:8560 N SILVERY LN
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4515
Practice Address - Country:US
Practice Address - Phone:248-525-8697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
00-111-000OtherAUTO INSURANCE