OrganizationActive
Great Lakes Pain Management MD, PC
NPI 1356419543 · Interventional Pain Medicine Physician · Wyandotte, MI
Provider details
- NPI number
- 1356419543
- Entity type
- Organization
- Primary specialty
- Interventional Pain Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Mohamed Othman, President(734) 282-4200
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1404 Eureka Ave
Wyandotte, MI 48192
Phone: (734) 282-4200
Fax: (734) 282-4210
Street-level locationGet directions
Mailing address
1404 Eureka Ave
Wyandotte, MI 48192
Registry dates
- Enumerated
- 2006-12-04
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.