Provider Demographics
NPI:1609049014
Name:MICHAEL S GORBACK MD PA
Entity Type:Organization
Organization Name:MICHAEL S GORBACK MD PA
Other - Org Name:THE CENTER FOR PAIN RELIEF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-554-3400
Mailing Address - Street 1:17099 TEXAS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4039
Mailing Address - Country:US
Mailing Address - Phone:281-554-3400
Mailing Address - Fax:281-554-3404
Practice Address - Street 1:17099 TEXAS AVE STE 300
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4039
Practice Address - Country:US
Practice Address - Phone:281-554-3400
Practice Address - Fax:281-554-3404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL S GORBACK, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-07
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7502208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA34138Medicare UPIN