Provider Demographics
NPI:1316307861
Name:PAIN MANAGEMENT CENTER OF MICHIGAN PLC
Entity type:Organization
Organization Name:PAIN MANAGEMENT CENTER OF MICHIGAN PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-927-9262
Mailing Address - Street 1:2500 NORTH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2270
Mailing Address - Country:US
Mailing Address - Phone:810-616-7246
Mailing Address - Fax:
Practice Address - Street 1:2500 NORTH RD STE 101
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2270
Practice Address - Country:US
Practice Address - Phone:810-616-7246
Practice Address - Fax:855-709-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098958207LP2900X
208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty