Provider Demographics
NPI:1942496443
Name:SUNRISE INSTITUTE FOR PAIN MANAGEMENT P.C.
Entity Type:Organization
Organization Name:SUNRISE INSTITUTE FOR PAIN MANAGEMENT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOWACKI M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-813-0060
Mailing Address - Street 1:6535 ROCHESTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1362
Mailing Address - Country:US
Mailing Address - Phone:248-813-0600
Mailing Address - Fax:248-813-0066
Practice Address - Street 1:6535 ROCHESTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1362
Practice Address - Country:US
Practice Address - Phone:248-813-0600
Practice Address - Fax:248-813-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080069208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty