23D2006434 CLIA NUMBER - MICHIGAN INSTITUTE OF PAIN AND HEADACHE

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Laboratory Demographics

CLIA Number: 23D2006434

Facility Name: MICHIGAN INSTITUTE OF PAIN AND HEADACHE

Facility Address:
21751 W 11 MILE ROAD SUITE 215
SOUTHFIELD, MI
ZIP 48076
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Facility Phone Number: 248 212-0256

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609077783

Taxonomy: 2086S0129X - Surgery
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

CLIA Record

Field Name	Field Value
CLIA Number	23D2006434
LAB Type	Physician Office
Facility Name	MICHIGAN INSTITUTE OF PAIN AND HEADACHE
Street	21751 W 11 MILE ROAD SUITE 215
City	SOUTHFIELD
State	MI
ZIP	48076
Phone	248 212-0256
CertificateType	4
CertificateEffectiveDate	4/7/2024
CertificateExpirationDate	4/6/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024