Provider Demographics
NPI:1447855523
Name:MICHIGAN ORTHOPEDIC CARE & SPINE INSTITUTE PLLC
Entity type:Organization
Organization Name:MICHIGAN ORTHOPEDIC CARE & SPINE INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAII
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-520-0200
Mailing Address - Street 1:5560 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3648
Mailing Address - Country:US
Mailing Address - Phone:630-234-0910
Mailing Address - Fax:
Practice Address - Street 1:4520 FIRESTONE ST STE C
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4602
Practice Address - Country:US
Practice Address - Phone:515-520-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty