Provider Demographics
NPI:1225104151
Name:EMERGENCY NEUROSURGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:EMERGENCY NEUROSURGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROISSANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-751-7246
Mailing Address - Street 1:7650 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2078
Mailing Address - Country:US
Mailing Address - Phone:248-620-9310
Mailing Address - Fax:248-922-5945
Practice Address - Street 1:7650 DIXIE HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2078
Practice Address - Country:US
Practice Address - Phone:248-620-9310
Practice Address - Fax:248-922-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404978207T00000X
MI4301029245207T00000X
MI4301038657207T00000X
MI4301066041207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P14180Medicare ID - Type Unspecified