Healthcare Provider Details

I. General information

NPI: 1861819161
Provider Name (Legal Business Name): MICHIGAN INTERVENTIONAL PAIN ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD SUITE 2100
WEST BLOOMFIELD MI
48323-2184
US

IV. Provider business mailing address

2300 HAGGERTY RD STE 2100
WEST BLOOMFIELD MI
48323-2191
US

V. Phone/Fax

Practice location:
  • Phone: 248-624-7246
  • Fax:
Mailing address:
  • Phone: 248-624-7246
  • Fax: 248-624-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WIENER
Title or Position: OWNER
Credential: MD
Phone: 248-624-7246