Provider Demographics
NPI:1407385529
Name:PROVIDER SERVICES NETWORK LLC
Entity Type:Organization
Organization Name:PROVIDER SERVICES NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-225-4492
Mailing Address - Street 1:31500 W 13 MILE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2172
Mailing Address - Country:US
Mailing Address - Phone:248-220-0600
Mailing Address - Fax:248-579-9096
Practice Address - Street 1:31500 W 13 MILE RD STE 106
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2172
Practice Address - Country:US
Practice Address - Phone:248-220-0600
Practice Address - Fax:248-579-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080436208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty