1801050083 NPI number — MICHIGAN PAIN CLINIC ASSOCIATES PC

Table of content: KATHERINE LAURA OLSHAN MD (NPI 1932596855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801050083 NPI number — MICHIGAN PAIN CLINIC ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN PAIN CLINIC ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801050083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5456 15 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48310-5110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-978-7250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5456 15 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48310-5110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-977-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VAKHARIYA
Authorized Official First Name:
RAKESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-977-7246

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  4301087912 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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