Healthcare Provider Details

I. General information

NPI: 1376907956
Provider Name (Legal Business Name): SPINE AND JOINT PAIN MANAGMENT CENTER,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3273 BEECHER RD
FLINT MI
48532-3615
US

IV. Provider business mailing address

1221 BOWERS ST UNIT 2653
BIRMINGHAM MI
48012-7107
US

V. Phone/Fax

Practice location:
  • Phone: 248-234-3101
  • Fax: 248-281-3535
Mailing address:
  • Phone: 248-200-7756
  • Fax: 248-281-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4301097463
License Number StateMI

VIII. Authorized Official

Name: MUHAMMAD AHSAN
Title or Position: PRESIDENT
Credential: MD
Phone: 937-673-3983