Healthcare Provider Details

I. General information

NPI: 1598081317
Provider Name (Legal Business Name): MICHIGAN INSTITUTE OF PAIN MANAGEMENT WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 BELLEVILLE ROAD
VAN BUREN TOWNSHIP MI
48111
US

IV. Provider business mailing address

PO BOX 1665
BELLEVILLE MI
48112-1665
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-6782
  • Fax: 313-565-6784
Mailing address:
  • Phone: 313-565-6782
  • Fax: 313-565-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HUSSEIN ABDURAHMAN HURAIBI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 313-565-6782