Healthcare Provider Details

I. General information

NPI: 1437257557
Provider Name (Legal Business Name): MICHIGAN PAIN INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR
YPSILANTI MI
48197-1014
US

IV. Provider business mailing address

2006 HOGBACK RD SUITE 5
ANN ARBOR MI
48105-9750
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-7246
  • Fax: 734-712-5084
Mailing address:
  • Phone: 734-786-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301058939
License Number StateMI

VIII. Authorized Official

Name: TRACI COFFMAN
Title or Position: CHAIR
Credential: MD
Phone: 734-263-2395