Provider Demographics
NPI:1437776689
Name:NEUROSPINE COVERAGE PLLC
Entity Type:Organization
Organization Name:NEUROSPINE COVERAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-809-3240
Mailing Address - Street 1:29425 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1080
Mailing Address - Country:US
Mailing Address - Phone:248-809-3240
Mailing Address - Fax:
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:313-463-8676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty