Healthcare Provider Details

I. General information

NPI: 1841444007
Provider Name (Legal Business Name): MICHIGAN INTERVENTIONAL RADIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4466 W BRISTOL RD FL 2
FLINT MI
48507-3170
US

IV. Provider business mailing address

4466 W BRISTOL RD FL 2
FLINT MI
48507-3170
US

V. Phone/Fax

Practice location:
  • Phone: 810-250-4866
  • Fax: 810-250-4867
Mailing address:
  • Phone: 810-250-4866
  • Fax: 810-250-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ERIN STONEBURG
Title or Position: OFFICE MANAGER
Credential:
Phone: 810-250-4866