Provider Demographics
NPI:1033445358
Name:MILAN BEHAVIORAL AND PAIN SOLUTIONS
Entity Type:Organization
Organization Name:MILAN BEHAVIORAL AND PAIN SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-645-7289
Mailing Address - Street 1:3 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1248
Mailing Address - Country:US
Mailing Address - Phone:734-439-7480
Mailing Address - Fax:734-439-1384
Practice Address - Street 1:3 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1248
Practice Address - Country:US
Practice Address - Phone:734-439-7480
Practice Address - Fax:734-439-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010354762084P0800X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0817222OtherBCBSM
MI1801941281OtherNPI
0817222OtherBCBSM
MIB46896Medicare UPIN