Healthcare Provider Details

I. General information

NPI: 1699916452
Provider Name (Legal Business Name): HIGHLANDS INTERVENTIONAL PAIN MANAGEMENT P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2009
Last Update Date: 03/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 19 MILE RD STE 100
CLINTON TOWNSHIP MI
48038-1148
US

IV. Provider business mailing address

PO BOX 2756
CLIFTON NJ
07015-2756
US

V. Phone/Fax

Practice location:
  • Phone: 586-907-5656
  • Fax: 973-772-8012
Mailing address:
  • Phone: 586-907-5656
  • Fax: 973-772-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number5101018041
License Number StateMI

VIII. Authorized Official

Name: DR. ROSS LOUIS NOCHIMSON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 586-907-5656