Provider Demographics
NPI:1760176408
Name:WEST MICHIGAN INTERVENTIONAL PAIN & SPINE, PLLC
Entity Type:Organization
Organization Name:WEST MICHIGAN INTERVENTIONAL PAIN & SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KWIECIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-765-1803
Mailing Address - Street 1:9 LABELLE TER
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9611
Mailing Address - Country:US
Mailing Address - Phone:734-765-1803
Mailing Address - Fax:
Practice Address - Street 1:6400 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9255
Practice Address - Country:US
Practice Address - Phone:269-263-6089
Practice Address - Fax:269-263-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty