Provider Demographics
NPI:1578003307
Name:STERLING HEIGHTS PAIN MANAGEMENT
Entity Type:Organization
Organization Name:STERLING HEIGHTS PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-644-2880
Mailing Address - Street 1:2311 15 MILE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4842
Mailing Address - Country:US
Mailing Address - Phone:586-698-2290
Mailing Address - Fax:586-275-2274
Practice Address - Street 1:2311 15 MILE RD
Practice Address - Street 2:SUITE B
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4842
Practice Address - Country:US
Practice Address - Phone:586-698-2290
Practice Address - Fax:586-275-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020822208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2791Medicare UPIN