Provider Demographics
NPI:1275840043
Name:MICHIGAN NEUROSURGEONS,PLLC
Entity Type:Organization
Organization Name:MICHIGAN NEUROSURGEONS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTRUO
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-591-9040
Mailing Address - Street 1:15142 LEVAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5027
Mailing Address - Country:US
Mailing Address - Phone:734-591-9040
Mailing Address - Fax:734-591-0028
Practice Address - Street 1:15142 LEVAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5027
Practice Address - Country:US
Practice Address - Phone:734-591-9040
Practice Address - Fax:734-591-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI032527207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105212810Medicaid
MI1052128-10Medicaid
MI1052128-10Medicaid
MID72825Medicare PIN