Provider Demographics
NPI:1952448417
Name:PAIN CLINIC OF MICHIGAN PC
Entity Type:Organization
Organization Name:PAIN CLINIC OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:
Authorized Official - Last Name:KERKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-978-7250
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-0548
Mailing Address - Country:US
Mailing Address - Phone:248-652-7520
Mailing Address - Fax:
Practice Address - Street 1:5440 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5111
Practice Address - Country:US
Practice Address - Phone:586-978-7250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty