Provider Demographics
NPI:1225212996
Name:PROFESSIONAL PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:PROFESSIONAL PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHANZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-808-3500
Mailing Address - Street 1:3355 EAGLE PARK DR NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7004
Mailing Address - Country:US
Mailing Address - Phone:616-808-3500
Mailing Address - Fax:616-808-3740
Practice Address - Street 1:3355 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 106
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7004
Practice Address - Country:US
Practice Address - Phone:616-808-3500
Practice Address - Fax:616-808-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011044208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P52930Medicare PIN
MIF23881Medicare UPIN