Provider Demographics
NPI:1659798627
Name:SPINE AND JOINT PAIN MANAGEMENT CENTER PC
Entity Type:Organization
Organization Name:SPINE AND JOINT PAIN MANAGEMENT CENTER PC
Other - Org Name:SPINE AND JOINT PAIN MANAGEMENT CENTER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:KAMRAN
Authorized Official - Last Name:AHSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-673-3983
Mailing Address - Street 1:1221 BOWERS ST UNIT 2653
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-7104
Mailing Address - Country:US
Mailing Address - Phone:937-673-3983
Mailing Address - Fax:248-281-3535
Practice Address - Street 1:20180 W 12 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5412
Practice Address - Country:US
Practice Address - Phone:248-200-7756
Practice Address - Fax:248-281-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097463207R00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty