Provider Demographics
NPI:1154181600
Name:MI INTERVENTIONAL PAIN AND REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:MI INTERVENTIONAL PAIN AND REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BATHINAIAH
Authorized Official - Middle Name:RAJU
Authorized Official - Last Name:VORAKKARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-319-6630
Mailing Address - Street 1:4466 W BRISTOL RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42500 HAYES RD STE 800
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6761
Practice Address - Country:US
Practice Address - Phone:248-319-6630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center