Provider Demographics
NPI:1518588078
Name:MACKINAC NEUROLOGY
Entity Type:Organization
Organization Name:MACKINAC NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-505-2525
Mailing Address - Street 1:PO BOX 2005
Mailing Address - Street 2:
Mailing Address - City:MACKINAC ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49757-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8350 CEDAR CT
Practice Address - Street 2:
Practice Address - City:MACKINAC ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49757
Practice Address - Country:US
Practice Address - Phone:906-430-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty