# MILLENIUM PAIN MANAGEMENT & THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174800981
- **Authorized official:** DR. JORAM O MOGAKA MD (CEO)
- **Authorized official phone:** (586) 777-0630

## Contact information

- **Practice address:** 21409 KELLY RD, STE 400, EASTPOINTE, MI 48021-3264
- **Practice address phone:** (586) 777-0630
- **Mailing address:** PO BOX 2666, FARMINGTON HILLS, MI 48333-2666
- **Mailing address phone:** (586) 777-0630

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 11/08/2011
- **Last updated:** 11/08/2011