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General NPI Number Information
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NPI Number | 1043463672
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Entity Type | Organization
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Legal Business Name | ADVANCED PAIN & SPINE INSTITUTE PC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 18100 OAKWOOD BLVD SUITE 203
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City | DEARBORN
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State | MI
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Zip | 48124-4085
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Country | US
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Telephone | 313-434-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 18100 OAKWOOD BLVD SUITE 203
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City | DEARBORN
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State | MI
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Zip | 48124-4085
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Country | US
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Telephone | 313-434-7246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL MEKASHA
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Credential |
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Telephone | 313-434-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State | MI
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