Provider Demographics
NPI:1386686665
Name:MILESTONE PAIN AND REHABILITATION,PC
Entity Type:Organization
Organization Name:MILESTONE PAIN AND REHABILITATION,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PH.D., M.D.
Authorized Official - Prefix:
Authorized Official - First Name:GHOLAMREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAREGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-965-8001
Mailing Address - Street 1:8981 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7055 TOWER RD
Practice Address - Street 2:SUITE C
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8604
Practice Address - Country:US
Practice Address - Phone:269-965-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N92890Medicare ID - Type Unspecified