Provider Demographics
NPI:1437257557
Name:MICHIGAN PAIN INSTITUTE, PLLC
Entity Type:Organization
Organization Name:MICHIGAN PAIN INSTITUTE, PLLC
Other - Org Name:MICHIGAN PAIN INSITUTE, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-263-2395
Mailing Address - Street 1:2006 HOGBACK RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9750
Mailing Address - Country:US
Mailing Address - Phone:734-786-2317
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-7246
Practice Address - Fax:734-712-5084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANESTHESIA ASSOCIATES OF MICHIGAN, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058939207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H11063OtherBCBS
MICF9179OtherRAILROAD MEDICARE PIN
MICF9179OtherRAILROAD MEDICARE PIN
MI0P07370Medicare ID - Type Unspecified
MICF9179OtherRAILROAD MEDICARE PIN
MICF9179Medicare PIN