Provider Demographics
NPI:1740567163
Name:NORTHVILLE PAIN SPECIALISTS PLC
Entity Type:Organization
Organization Name:NORTHVILLE PAIN SPECIALISTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREYDL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-773-7964
Mailing Address - Street 1:215 E. MAIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1686
Mailing Address - Country:US
Mailing Address - Phone:248-773-7964
Mailing Address - Fax:248-773-7994
Practice Address - Street 1:215 E. MAIN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1686
Practice Address - Country:US
Practice Address - Phone:248-773-7964
Practice Address - Fax:248-773-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015444208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5822157OtherBCBSM
MI06591YMedicare UPIN