Provider Demographics
NPI:1538325972
Name:UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Other - Org Name:MICHIGAN HEAD AND SPINE INSTITUTE, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-784-3667
Mailing Address - Street 1:3555 W 13 MILE RD
Mailing Address - Street 2:STE N220
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:877-784-3667
Mailing Address - Fax:
Practice Address - Street 1:3555 W 13 MILE RD
Practice Address - Street 2:STE N220
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
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:2008-08-05
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26462Medicare PIN