Provider Demographics
NPI:1699048702
Name:NEURO PAIN CONSULTANTS PC
Entity type:Organization
Organization Name:NEURO PAIN CONSULTANTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-605-7331
Mailing Address - Street 1:799 DENISON CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0053
Mailing Address - Country:US
Mailing Address - Phone:248-751-7246
Mailing Address - Fax:248-418-2311
Practice Address - Street 1:799 DENISON CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0053
Practice Address - Country:US
Practice Address - Phone:248-751-7246
Practice Address - Fax:248-418-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072377207L00000X
MI4301087884207L00000X
MI5101016093207L00000X
MI4301058094207L00000X
MI4301063268207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F318300OtherBCBS OF MICHIGAN
MI0N37000Medicare PIN