Provider Demographics
NPI:1629568811
Name:FLINT PAIN SPECIALISTS PLLC
Entity Type:Organization
Organization Name:FLINT PAIN SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-644-2880
Mailing Address - Street 1:1345 WILLOWDALE CT STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4737
Mailing Address - Country:US
Mailing Address - Phone:954-644-2880
Mailing Address - Fax:
Practice Address - Street 1:1345 WILLOWDALE CT STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4737
Practice Address - Country:US
Practice Address - Phone:954-644-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020822207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG27091OtherUPIN