Healthcare Provider Details

I. General information

NPI: 1366693616
Provider Name (Legal Business Name): MICHIGAN INSTITUTE OF PAIN AND HEADACHE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21751 W 11 MILE RD STE 215
SOUTHFIELD MI
48076-3780
US

IV. Provider business mailing address

21751 W 11 MILE RD STE 215
SOUTHFIELD MI
48076-3780
US

V. Phone/Fax

Practice location:
  • Phone: 248-212-0256
  • Fax: 248-356-3000
Mailing address:
  • Phone: 248-212-0256
  • Fax: 248-356-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NAZIH S ISKANDER
Title or Position: CFO
Credential:
Phone: 248-212-0256