Healthcare Provider Details

I. General information

NPI: 1538816194
Provider Name (Legal Business Name): MINIMALLY INVASIVE PAIN SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 15 MILE RD STE C
STERLING HEIGHTS MI
48312-3621
US

IV. Provider business mailing address

30713 SCHOENHERR RD STE A
WARREN MI
48088-3122
US

V. Phone/Fax

Practice location:
  • Phone: 586-284-2643
  • Fax: 586-265-2170
Mailing address:
  • Phone: 586-284-2643
  • Fax: 586-265-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN MOHAMAD HIJAZI
Title or Position: OWNER
Credential: DO
Phone: 279-321-9348