Provider Demographics
NPI:1689184020
Name:MIDWEST SURGICAL AFFILIATES, PLLC
Entity Type:Organization
Organization Name:MIDWEST SURGICAL AFFILIATES, PLLC
Other - Org Name:COMPLETE PAIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-581-3255
Mailing Address - Street 1:8560 N SILVERY LN STE 202
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4515
Mailing Address - Country:US
Mailing Address - Phone:313-581-3255
Mailing Address - Fax:313-581-3755
Practice Address - Street 1:8560 N SILVERY LN STE 202
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4515
Practice Address - Country:US
Practice Address - Phone:313-581-3255
Practice Address - Fax:313-581-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015792208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty