Provider Demographics
NPI:1659683134
Name:THE PAIN CENTER USA PLLC
Entity Type:Organization
Organization Name:THE PAIN CENTER USA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-757-4000
Mailing Address - Street 1:22480 KELLY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2623
Mailing Address - Country:US
Mailing Address - Phone:586-776-7400
Mailing Address - Fax:586-776-8600
Practice Address - Street 1:22480 KELLY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2623
Practice Address - Country:US
Practice Address - Phone:586-776-7400
Practice Address - Fax:586-776-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N87120Medicare PIN