Provider Services Network LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

4301080436 Issued in MI

Legal business name

PROVIDER SERVICES NETWORK LLC

Practice address

31500 W 13 Mile Rd Ste 106
Farmington Hills, MI 48334-2172

Phone

(248) 220-0600

Fax

(248) 579-9096

NPI assigned

Jun 12, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohammad K Jaura

Title

Owner

Phone

(248) 225-4492

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ralph Wiktor, PA-C

  • Physician Assistant
  • Grand Blanc, MI
  • NPI 1285674044
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1407385529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31500 W 13 MILE RD STE 106",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483342172",
            "telephone_number": "248-220-0600",
            "fax_number": "248-579-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31500 W 13 MILE RD STE 106",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483342172",
            "telephone_number": "248-220-0600",
            "fax_number": "248-579-9096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER SERVICES NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JAURA",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-225-4492"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "MI",
            "license": "4301080436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanisha Proudie
• Paige Proudlock
• Lindsay Proulx
• Amanda Provencher
• Tara Provencher
• Provider Wellness Group, LLC
• Jeffrey Louis Provizer, DO
• Kari K Provizer, LMSW, ACSW
• Noah Provizer, DDS
• Sebra Provost

• Pain Medicine Physician in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Pain Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.