Organization
GREAT LAKES PAIN MANAGEMENT MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMED L OTHMAN M.D. (PRESIDENT)
(734) 282-4200
Entity
Organization
Contact information
Practice address
1404 EUREKA AVE, WYANDOTTE, MI 48192
(734) 282-4200
(734) 282-4210
Mailing address
1404 EUREKA AVE, WYANDOTTE, MI 48192
(734) 282-4200
(734) 282-4210
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
12/04/2006
Last updated
08/22/2020
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