Provider Demographics
NPI:1487972766
Name:AMERICAN PAIN & SPINE CENTER, P.C.
Entity type:Organization
Organization Name:AMERICAN PAIN & SPINE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:AREF
Authorized Official - Last Name:OSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-586-4030
Mailing Address - Street 1:3845 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4607
Mailing Address - Country:US
Mailing Address - Phone:313-586-4030
Mailing Address - Fax:313-586-4031
Practice Address - Street 1:3845 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4607
Practice Address - Country:US
Practice Address - Phone:313-586-4030
Practice Address - Fax:313-586-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085721208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487972766Medicaid