GREAT LAKES PAIN MANAGEMENT MD, PC (NPI# 1356419543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356419543 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES PAIN MANAGEMENT MD, PC |
| Practice Address |
1404 Eureka Ave Wyandotte MI 48192 |
| Practice Telephone | 7342824200 |
| Practice Fax Number | 7342824210 |
| Mailing Telephone | 7342824200 |
| Mailing Fax Number | 7342824210 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MOHAMED L OTHMAN (PRESIDENT) |
| Authorized Official Telephone | 7342824200 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
1404 EUREKA AVE |
| City | WYANDOTTE |
| State | MI |
| Zip Code | 48192 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912541673 | Wayne Pharma | Pharmacy | 974 Ford Ave, Wyandotte, MI 48192 | 2019-11-05 |
| 1598226029 | Alicia Paulette Flores | Emergency Medicine | Henry Ford Wyandotte Hosptial, Medical Education, 2333 Biddle Ave, Wyandotte, MI 48192 | 2019-03-27 |
| 1912483819 | Fast Care Pharmacy LLC | Pharmacy | 1209 Fort St, Wyandotte, MI 48192 | 2018-07-13 |
| 1518464106 | Tyson Reed Mckechnie | Emergency Medicine | Henry Ford Wyandotte Hospital, Medical Education Dept., 2333 Biddle Ave., Wyandotte, MI 48192 | 2018-04-10 |
| 1275038572 | Joanna Fourtounis | Emergency Medicine | Henry Ford Wyandotte Medical Education Office, 2333 Biddle Ave, Wyandotte, MI 48192 | 2018-03-28 |
| 1841794120 | Henry Tan | Student in an Organized Health Care Education/Training Program | Henry Ford Wyandotte Hospital, Medical Education Depart, 2333 Biddle Ave, Wyandotte, MI 48192 | 2018-03-21 |
| 1174042857 | Ashley Marie Kobylasz | Social Worker | 1506 16th Street, Wyandotte, MI 48192 | 2017-09-14 |
| 1831630631 | Vanessa Majeski | Surgery | 8333 Biddle Ave, Henry Ford Wyandotte Hospital, Wyandotte, MI 48192 | 2017-03-13 |
| 1346796984 | Jordan Yagiela | Community/Behavioral Health | 1940 Ludington Street, Wyandotte, MI 48192 | 2016-09-01 |
| 1649642505 | Superior Visions Inc | In Home Supportive Care | 2709 Fort Street, Wyandotte, MI 48192 | 2015-10-30 |
| Find all providers in zip 48192 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558903294 | Comprehensive Pain Specialists, Pllc | Pain Medicine | 4302 Bay City Rd, Midland, MI 48642-6014 | 2019-10-15 |
| 1437715232 | Comprehensive Pain Specialists, Pllc | Pain Medicine | 705 E Frank St, Caro, MI 48723 | 2019-05-16 |
| 1083175913 | Bella Treatment Center PC | Pain Medicine | 28763 Northwestern Hwy Ste 100, Southfield, MI 48034-1842 | 2019-03-25 |
| 1245795848 | Advanced Pain Management Specialists, LLC | Pain Medicine | 46325 W 12 Mile Rd Ste 335, Novi, MI 48377-2464 | 2019-02-07 |
| 1356738686 | Genesee Pain Associates PC | Pain Medicine | 4468 Oakbridge Dr, Flint, MI 48532-5422 | 2015-04-24 |
| 1457745150 | Strategy Anesthesia Michigan Pllc | Pain Medicine | 13460 Fort St, Southgate, MI 48195-1138 | 2015-03-20 |
| 1407115884 | Michiana Spine, Sports & Occupational Rehab, PC | Pain Medicine | 2500 Niles Rd Ste 3, Saint Joseph, MI 49085-3225 | 2012-05-07 |
| 1386902013 | Michiana Spine, Sports & Occupational Rehab, PC | Pain Medicine | 24 N Saint Joseph Ave Ste B, Niles, MI 49120-2263 | 2012-05-01 |
| 1225302821 | Pain Clinic Management Group, Pllc | Pain Medicine | 35634 Dequindre Rd, Sterling Heights, MI 48310-4288 | 2012-02-28 |
| 1740567163 | Northville Pain Specialists Plc | Pain Medicine | 215 E. Main Street, Suite 201, Northville, MI 48167-1686 | 2011-11-14 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on GREAT LAKES PAIN MANAGEMENT MD, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.