Provider Demographics
NPI:1821683053
Name:EDUCARE INTERVENTIONAL PAIN & ANESTHESIOLOGY
Entity Type:Organization
Organization Name:EDUCARE INTERVENTIONAL PAIN & ANESTHESIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GANIU
Authorized Official - Middle Name:
Authorized Official - Last Name:EDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-932-1350
Mailing Address - Street 1:2041 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2402
Mailing Address - Country:US
Mailing Address - Phone:313-551-5501
Mailing Address - Fax:
Practice Address - Street 1:2041 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2402
Practice Address - Country:US
Practice Address - Phone:313-551-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty