Provider Demographics
NPI:1225266075
Name:PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:GNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-697-2678
Mailing Address - Street 1:27472 SCHONEHERR
Mailing Address - Street 2:#130
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088
Mailing Address - Country:US
Mailing Address - Phone:586-697-2678
Mailing Address - Fax:586-540-0017
Practice Address - Street 1:27472 SCHONEHERR
Practice Address - Street 2:#130
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088
Practice Address - Country:US
Practice Address - Phone:586-697-2678
Practice Address - Fax:586-540-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013946208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty