Provider Demographics
NPI:1154717106
Name:EXCELLENT PAIN CONSULTANTS
Entity type:Organization
Organization Name:EXCELLENT PAIN CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:REVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-978-4433
Mailing Address - Street 1:15565 NORTHLAND DR W STE 304
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5313
Mailing Address - Country:US
Mailing Address - Phone:248-809-2010
Mailing Address - Fax:
Practice Address - Street 1:15565 NORTHLAND DR W STE 304
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5313
Practice Address - Country:US
Practice Address - Phone:248-809-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain