Provider Demographics
NPI:1912543737
Name:INTEGRATIVE PAIN SPECIALIST OF MICHIGAN PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE PAIN SPECIALIST OF MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-983-8133
Mailing Address - Street 1:9001 15 MILE RD STE C
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3621
Mailing Address - Country:US
Mailing Address - Phone:586-983-8133
Mailing Address - Fax:586-983-8135
Practice Address - Street 1:9001 15 MILE RD STE C
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3621
Practice Address - Country:US
Practice Address - Phone:586-983-8133
Practice Address - Fax:586-983-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT000680658391OtherAUTO INSURANCES