1386071231 NPI number — ACUPUNCTURE AND PAIN CLINIC CENTER PLLC

Table of content: (NPI 1386071231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386071231 NPI number — ACUPUNCTURE AND PAIN CLINIC CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACUPUNCTURE AND PAIN CLINIC CENTER PLLC
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:
1386071231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2608 WOODCREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48188-2642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-312-7786
Provider Business Mailing Address Fax Number:
313-584-0552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5141 OAKMAN BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-3763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-312-7786
Provider Business Practice Location Address Fax Number:
313-584-0552
Provider Enumeration Date:
10/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BELKHALFIA
Authorized Official First Name:
MOSTAFA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-312-7786

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  5401000061 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com