Provider Demographics
NPI:1902976699
Name:J&K PAIN MANAGEMENT COMPANY LLC
Entity Type:Organization
Organization Name:J&K PAIN MANAGEMENT COMPANY LLC
Other - Org Name:GREAT LAKES PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-306-2358
Mailing Address - Street 1:2760 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094
Mailing Address - Country:US
Mailing Address - Phone:440-306-2358
Mailing Address - Fax:440-306-2359
Practice Address - Street 1:2760 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-306-2358
Practice Address - Fax:440-306-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075570-M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2083810OtherUNITED HEALTH CARE
OH736496Medicaid
OHC75570OtherSUMMA CARE
OH352308Medicaid
OH7813229OtherAETNA
OH8076384OtherCIGNA
OH000000389088OtherANTHEM
OH2124534Medicaid
OHP00304928OtherRAILROAD MEDICARE
OHC75570OtherSUMMA CARE
OH352308Medicaid
OHC75570OtherSUMMA CARE
OH========= 027OtherCARESOURCE
OH8076384OtherCIGNA