Provider Demographics
NPI:1710022165
Name:PAIN MANAGEMENT AND REHAB CENTERS
Entity Type:Organization
Organization Name:PAIN MANAGEMENT AND REHAB CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUZAFFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-381-8860
Mailing Address - Street 1:640 3 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WEST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8209
Mailing Address - Country:US
Mailing Address - Phone:313-381-8860
Mailing Address - Fax:313-381-0721
Practice Address - Street 1:640 3 MILE RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8209
Practice Address - Country:US
Practice Address - Phone:313-381-8860
Practice Address - Fax:313-381-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP10170Medicare ID - Type Unspecified