Provider Demographics
NPI:1497379671
Name:UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-869-3965
Mailing Address - Street 1:25500 MEADOWBROOK RD STE 235
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1882
Mailing Address - Country:US
Mailing Address - Phone:248-869-3965
Mailing Address - Fax:
Practice Address - Street 1:5400 FORT ST STE 200
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4636
Practice Address - Country:US
Practice Address - Phone:877-784-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty