Provider Demographics
NPI:1952460081
Name:SOMERSET PAIN CLINIC PC
Entity Type:Organization
Organization Name:SOMERSET PAIN CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEID
Authorized Official - Middle Name:
Authorized Official - Last Name:COSOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-244-8700
Mailing Address - Street 1:PO BOX 99160
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9160
Mailing Address - Country:US
Mailing Address - Phone:248-244-8700
Mailing Address - Fax:248-244-8747
Practice Address - Street 1:888 W BIG BEAVER RD
Practice Address - Street 2:SUITE 309
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4736
Practice Address - Country:US
Practice Address - Phone:248-244-8700
Practice Address - Fax:248-244-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISC057395207QS0010X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3510124Medicaid
MI0806335011OtherBCBS
MIF53903Medicare UPIN
MI0N78860Medicare ID - Type Unspecified