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General NPI Number Information
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NPI Number | 1649740747
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Entity Type | Organization
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Legal Business Name | MICHIGAN INSTITUTE FOR INTERVENTIONAL PAIN PLLC
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 1234 S LAPEER RD
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City | LAKE ORION
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State | MI
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Zip | 48360-1433
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Country | US
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Telephone | 248-319-6630
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Fax | 248-319-6631
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Provider Business Mailing Address
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Address Line | 1234 S LAPEER RD
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City | LAKE ORION
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State | MI
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Zip | 48360-1433
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Country | US
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Telephone | 248-319-6630
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Fax | 248-319-6631
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Authorized Official
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Title or Position | OWNER
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Name | IHSAN ASBAHI
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Credential | M.D.
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Telephone | 248-227-7828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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