Provider Demographics
NPI:1114704764
Name:MICHIGAN MINIMALLY INVASIVE NEUROSURGICAL INSTITUTE PLLC
Entity Type:Organization
Organization Name:MICHIGAN MINIMALLY INVASIVE NEUROSURGICAL INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUELANGELO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEREZ-CRUET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-535-6952
Mailing Address - Street 1:1070 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2849
Mailing Address - Country:US
Mailing Address - Phone:248-383-1030
Mailing Address - Fax:248-383-1031
Practice Address - Street 1:5220 HIGHLAND RD STE 210
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1973
Practice Address - Country:US
Practice Address - Phone:248-383-1030
Practice Address - Fax:248-383-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty