Provider Demographics
NPI:1427416338
Name:SOUTHFIELD PAIN MANGEMENT
Entity Type:Organization
Organization Name:SOUTHFIELD PAIN MANGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-701-5222
Mailing Address - Street 1:28035 SOUTHFIELD RD
Mailing Address - Street 2:100
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2858
Mailing Address - Country:US
Mailing Address - Phone:248-701-5222
Mailing Address - Fax:
Practice Address - Street 1:28035 SOUTHFIELD RD
Practice Address - Street 2:100
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2858
Practice Address - Country:US
Practice Address - Phone:248-701-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406796208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043314164OtherNPI
MI1043314164OtherNPI