Provider Demographics
NPI:1982027041
Name:UNTIED PAIN THERAPIES PLLC
Entity Type:Organization
Organization Name:UNTIED PAIN THERAPIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-353-4108
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:DEPT 7034
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-8106
Mailing Address - Country:US
Mailing Address - Phone:734-526-8860
Mailing Address - Fax:
Practice Address - Street 1:6620 HIGHLAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1682
Practice Address - Country:US
Practice Address - Phone:248-461-6862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory