GREAT LAKES PAIN MANAGEMENT MD, PC
NPI 1356419543
Pain Medicine - Interventional Pain Medicine in Wyandotte, MI

Q: What is Great Lakes Pain Management MD, PC's NPI number?

The NPI number for Great Lakes Pain Management MD, PC is 1356419543. It was assigned to this organization in the NPPES registry on December 4, 2006.

Q: What is Great Lakes Pain Management MD, PC's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Active since December 04, 2006CLIA 23D2019550 · Waiver

1404 EUREKA AVE, WYANDOTTE, MI 48192(734) 282-4200(734) 282-4210 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Great Lakes Pain Management Md, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES PAIN MANAGEMENT MD, PC (NPI 1356419543) is a healthcare organization registered as an interventional pain medicine in Wyandotte, Michigan and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through January 31, 2027 and lists Mohamed L Othman, President, as its authorized official.

NPPES Registry Identity

NPI1356419543

Entity TypeOrganization

Primary Taxonomy208VP0014X

Legal Business NameGREAT LAKES PAIN MANAGEMENT MD, PC

Location Address1404 EUREKA AVEWyandotte, MI 48192

Mailing Address1404 Eureka AveWyandotte, MI 48192 · (734) 282-4200 · Fax (734) 282-4210

Phone(734) 282-4200

Fax(734) 282-4210

Organization SubpartNo

Authorized OfficialMohamed L OthmanPresident · (734) 282-4200

Enumeration DateDecember 4, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1356419543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPain Medicine · Interventional Pain MedicineAllopathic & Osteopathic Physicians

Taxonomy Code208VP0014X

Definition

Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.

1404 EUREKA AVE, Wyandotte, MI 48192

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D2019550

Great Lakes Pain Management Center · Wyandotte, MI

Active · expires Jan 31, 2027

CLIA Number23D2019550

Laboratory TypePhysician Office

Certificate Effective DateFebruary 1, 2025

Certificate Expiration DateJanuary 31, 2027

Laboratory DirectorMohomed L. Osman

Laboratory Phone(734) 282-4200

Laboratory LocationGreat Lakes Pain Management Center2325 Eureka Avenue, Wyandotte, MI 48192

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Pain Management MD, PC's NPI number?

The NPI number for Great Lakes Pain Management MD, PC is 1356419543. It was assigned to this organization in the NPPES registry on December 4, 2006.

Where is Great Lakes Pain Management MD, PC located?

Great Lakes Pain Management MD, PC is located at 1404 Eureka Ave, Wyandotte, MI 48192. The listed phone number is (734) 282-4200.

What is Great Lakes Pain Management MD, PC's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Does Great Lakes Pain Management MD, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D2019550) is associated with this NPI, valid through January 31, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Great Lakes Pain Management MD, PC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Great Lakes Pain Management MD, PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Great Lakes Pain Management MD, PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.