Provider Demographics
NPI:1154075042
Name:AFFILIATED KNEE PAIN SPECIALISTS PLLC
Entity Type:Organization
Organization Name:AFFILIATED KNEE PAIN SPECIALISTS PLLC
Other - Org Name:NU LIFE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KALLABAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-331-1700
Mailing Address - Street 1:31333 SOUTHFIELD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8565 N SILVERY LN STE 402
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4518
Practice Address - Country:US
Practice Address - Phone:313-512-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty