Provider Demographics
NPI:1174992945
Name:EAST WEST PAIN INSTITUTE, PLLC
Entity type:Organization
Organization Name:EAST WEST PAIN INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHUSHOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRABORTTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-709-2526
Mailing Address - Street 1:425 N PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3189
Mailing Address - Country:US
Mailing Address - Phone:248-709-2526
Mailing Address - Fax:
Practice Address - Street 1:425 N PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3189
Practice Address - Country:US
Practice Address - Phone:248-709-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty