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General NPI Number Information
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NPI Number | 1609340215
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Entity Type | Organization
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Legal Business Name | MICHIGAN ORTHOPEDIC SPINE & INTERVENTIONALIST PLLC
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 17290 STONEBROOK DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-4324
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Country | US
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Telephone | 989-600-0242
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250665
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48325-0665
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BACHU ABRAHAM
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Credential | MD
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Telephone | 989-600-0242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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