| Organization Name: | PAIN MANAGEMENT CENTER |
| NPI Number: | 1225266075 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA RENE GNAS (MEDICAL DIRECTOR) |
| Mailing Address: | 27472 Schoneherr #130 Warren |
| State: | MI US |
| Postal Code: | 48088 |
| Phone Number: | 5866972678 |
| Fax Number: | 5865400017 |
| NPI Enumeration Date: | 06/30/2009 |
| NPI Last Update Date: | 06/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101013946 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |