MEDICARE: MICHIGAN INSTITUTE OF PAIN MANAGEMENT WEST

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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1598081317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN INSTITUTE OF PAIN MANAGEMENT WEST

Provider Business Mailing Address
First Line	:	PO BOX 1665
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48112-1665
Country	:	US
Telephone Number	:	313-565-6782
Fax Number	:	313-565-6784

Provider Business Practice Location Address
First Line	:	11650 BELLEVILLE ROAD
Second Line	:
City	:	VAN BUREN TOWNSHIP
State	:	MI
Zip	:	48111
Country	:	US
Telephone Number	:	313-565-6782
Fax Number	:	313-565-6784

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	HUSSEIN ABDURAHMAN HURAIBI
Credential	:	M.D.
Telephone Number	:	313-565-6782

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	04/19/2010

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