MEDICARE: MICHIGAN INTERVENTIONAL PAIN CENTER,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1053356774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN INTERVENTIONAL PAIN CENTER,PC

Provider Business Mailing Address
First Line	:	1701 LAKE LANSING RD
Second Line	:	SUITE 100
City	:	LANSING
State	:	MI
Zip	:	48912-3798
Country	:	US
Telephone Number	:	517-485-0001
Fax Number	:	517-485-1138

Provider Business Practice Location Address
First Line	:	19725 ALLEN RD
Second Line	:
City	:	BROWNSTOWN TWP
State	:	MI
Zip	:	48183-1021
Country	:	US
Telephone Number	:	734-479-7246
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	RAZMIG HALADJIAN
Credential	:
Telephone Number	:	734-479-7246

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/22/2020

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