Provider Demographics
NPI:1184044976
Name:MICHIGAN PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:MICHIGAN PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-632-8938
Mailing Address - Street 1:30301 WOODWARD AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0979
Mailing Address - Country:US
Mailing Address - Phone:248-632-8938
Mailing Address - Fax:248-291-5333
Practice Address - Street 1:30301 WOODWARD AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0979
Practice Address - Country:US
Practice Address - Phone:248-632-8938
Practice Address - Fax:248-291-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020822208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101020822OtherMEDICAL LICENSE