Provider Demographics
NPI:1124402607
Name:INTERVENTIONAL PAIN SPECIALISTS OF MICHIGAN PLLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN SPECIALISTS OF MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SIVA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SRIPADA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-275-9152
Mailing Address - Street 1:14000 DIX TOLEDO RD
Mailing Address - Street 2:PO BOX 1915
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-9500
Mailing Address - Country:US
Mailing Address - Phone:313-263-5961
Mailing Address - Fax:313-263-5963
Practice Address - Street 1:13460 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1138
Practice Address - Country:US
Practice Address - Phone:313-263-5961
Practice Address - Fax:313-263-5963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016685208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty