Provider Demographics
NPI:1902356140
Name:MIDMICHIGAN PAIN
Entity Type:Organization
Organization Name:MIDMICHIGAN PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TOLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-317-8000
Mailing Address - Street 1:2305 HAWTHORN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1202
Mailing Address - Country:US
Mailing Address - Phone:989-317-8000
Mailing Address - Fax:989-317-8536
Practice Address - Street 1:2305 HAWTHORN DR
Practice Address - Street 2:SUITE B
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1202
Practice Address - Country:US
Practice Address - Phone:989-317-8000
Practice Address - Fax:989-317-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7072119Medicaid
MI7072119Medicaid