Provider Demographics
NPI:1356536064
Name:PAIN AND REHABILITATION PHYSICIANS. P.C.
Entity type:Organization
Organization Name:PAIN AND REHABILITATION PHYSICIANS. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:OBAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-331-1900
Mailing Address - Street 1:26333 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4574
Mailing Address - Country:US
Mailing Address - Phone:248-331-1900
Mailing Address - Fax:
Practice Address - Street 1:26333 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4574
Practice Address - Country:US
Practice Address - Phone:248-331-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010623972081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N95840Medicare PIN