Provider Demographics
NPI:1467227603
Name:SPINEMD OF MICHIGAN, PLLC
Entity Type:Organization
Organization Name:SPINEMD OF MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:OPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-538-8685
Mailing Address - Street 1:1770 S OCEAN BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7802
Mailing Address - Country:US
Mailing Address - Phone:800-538-8685
Mailing Address - Fax:954-634-4293
Practice Address - Street 1:13530 MICHIGAN AVE STE 110
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3575
Practice Address - Country:US
Practice Address - Phone:800-538-8685
Practice Address - Fax:954-634-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty