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General NPI Number Information
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NPI Number | 1861380453
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Entity Type | Organization
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Legal Business Name | ADVANCED SPECIALTY
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 25900 GREENFIELD RD # 146
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City | OAK PARK
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State | MI
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Zip | 48237-1292
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Country | US
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Telephone | 248-327-7212
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Fax | 248-728-4195
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Provider Business Mailing Address
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Address Line | 25900 GREENFIELD RD # 146
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City | OAK PARK
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State | MI
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Zip | 48237-1292
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Country | US
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Telephone | 248-327-7212
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Fax | 248-728-4195
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Authorized Official
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Title or Position | OWNER
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Name | RAHIMAH BEN-ASAD RAY-EL
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Credential |
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Telephone | 651-216-6680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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