Provider Demographics
NPI:1598081317
Name:MICHIGAN INSTITUTE OF PAIN MANAGEMENT WEST
Entity Type:Organization
Organization Name:MICHIGAN INSTITUTE OF PAIN MANAGEMENT WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:ABDURAHMAN
Authorized Official - Last Name:HURAIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-565-6782
Mailing Address - Street 1:PO BOX 1665
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48112-1665
Mailing Address - Country:US
Mailing Address - Phone:313-565-6782
Mailing Address - Fax:313-565-6784
Practice Address - Street 1:11650 BELLEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111
Practice Address - Country:US
Practice Address - Phone:313-565-6782
Practice Address - Fax:313-565-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP1233001Medicare PIN