Provider Demographics
NPI:1801347398
Name:ST CLAIR PAIN CONSULTANTS PC
Entity type:Organization
Organization Name:ST CLAIR PAIN CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-580-0015
Mailing Address - Street 1:432 S WASHINGTON AVE
Mailing Address - Street 2:UNIT 1101
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3854
Mailing Address - Country:US
Mailing Address - Phone:313-580-0015
Mailing Address - Fax:313-884-6313
Practice Address - Street 1:29751 LITTLE MACK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-6503
Practice Address - Country:US
Practice Address - Phone:313-580-0015
Practice Address - Fax:313-884-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty