Provider Demographics
NPI:1588892939
Name:AMERICAN INJURY AND PAIN CENTER, PLLC
Entity type:Organization
Organization Name:AMERICAN INJURY AND PAIN CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-882-5476
Mailing Address - Street 1:17200 E WARREN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2498
Mailing Address - Country:US
Mailing Address - Phone:313-882-5476
Mailing Address - Fax:313-882-5485
Practice Address - Street 1:17200 E WARREN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2498
Practice Address - Country:US
Practice Address - Phone:313-882-5476
Practice Address - Fax:313-882-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVG030430207Q00000X
MILR007201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty