Healthcare Provider Details

I. General information

NPI: 1326850488
Provider Name (Legal Business Name): MICHIGAN STATE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W MAPLE RD
CLAWSON MI
48017-1109
US

IV. Provider business mailing address

PO BOX 3
STERLING HEIGHTS MI
48311-0003
US

V. Phone/Fax

Practice location:
  • Phone: 586-256-3725
  • Fax:
Mailing address:
  • Phone: 586-256-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY OPPENHEIMER
Title or Position: PHYSICIAN
Credential: MD
Phone: 586-256-3725