Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Great Lakes Pain Management MD, PC

Organization Interventional Pain Medicine Physician · NPI 1356419543

Great Lakes Pain Management MD, PC is an Interventional Pain Medicine Physician in Wyandotte, Michigan. Registered with an NPI since 2006.

In the registry since
2006
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1404 Eureka Ave
Wyandotte, MI 48192
Phone: (734) 282-4200
Fax: (734) 282-4210
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Interventional Pain Medicine Physician (primary) Taxonomy 208VP0014X

Record details

NPI number1356419543
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mohamed Othman — President · (734) 282-4200
NPI enumeratedDecember 4, 2006
Last updated in NPPESAugust 22, 2020
Mailing address1404 Eureka Ave, Wyandotte, MI 48192

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