Provider Demographics
NPI:1649814757
Name:ESSENTIAL SPINE INTERVENTIONS PLLC
Entity type:Organization
Organization Name:ESSENTIAL SPINE INTERVENTIONS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:AL HAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-467-8030
Mailing Address - Street 1:19925 VERNIER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1486
Mailing Address - Country:US
Mailing Address - Phone:586-525-8503
Mailing Address - Fax:
Practice Address - Street 1:19925 VERNIER RD STE 200
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1486
Practice Address - Country:US
Practice Address - Phone:586-525-8503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty