Provider Demographics
NPI:1679763569
Name:PAIN CONSULTANTS OF MICHIGAN, PLC
Entity type:Organization
Organization Name:PAIN CONSULTANTS OF MICHIGAN, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-752-1900
Mailing Address - Street 1:1119 SOUTH WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601
Mailing Address - Country:US
Mailing Address - Phone:989-752-1900
Mailing Address - Fax:
Practice Address - Street 1:1119 SOUTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-752-1900
Practice Address - Fax:989-752-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty