Provider Demographics
NPI:1275280711
Name:SOUTHEAST MICHIGAN INTERVENTIONAL PAIN SPECIALISTS
Entity Type:Organization
Organization Name:SOUTHEAST MICHIGAN INTERVENTIONAL PAIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-470-8912
Mailing Address - Street 1:2841 MONROE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3492
Mailing Address - Country:US
Mailing Address - Phone:313-998-8662
Mailing Address - Fax:313-867-4581
Practice Address - Street 1:2841 MONROE ST FL 2
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3492
Practice Address - Country:US
Practice Address - Phone:313-998-8662
Practice Address - Fax:313-867-4581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty