Provider Demographics
NPI:1790226314
Name:NEXTGEN PAIN ASSOCIATES & REHABILITATION LLC
Entity type:Organization
Organization Name:NEXTGEN PAIN ASSOCIATES & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-528-0181
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-0564
Mailing Address - Country:US
Mailing Address - Phone:313-528-0181
Mailing Address - Fax:313-528-0182
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:STE 310
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:313-528-0181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain