1053356774 NPI number — MICHIGAN INTERVENTIONAL PAIN CENTER,PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053356774 NPI number — MICHIGAN INTERVENTIONAL PAIN CENTER,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN INTERVENTIONAL PAIN CENTER,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053356774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 LAKE LANSING RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48912-3798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-485-0001
Provider Business Mailing Address Fax Number:
517-485-1138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19725 ALLEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSTOWN TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-479-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALADJIAN
Authorized Official First Name:
RAZMIG
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
734-479-7246

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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