Provider Demographics
NPI:1760521298
Name:MICHIGAN BRAIN & SPINE INSTITUTE, PC
Entity Type:Organization
Organization Name:MICHIGAN BRAIN & SPINE INSTITUTE, PC
Other - Org Name:ANN ARBOR SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-434-4110
Mailing Address - Street 1:5315 ELLIOTT DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8634
Mailing Address - Country:US
Mailing Address - Phone:734-434-4110
Mailing Address - Fax:734-528-0987
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:SUITE 102
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-434-4110
Practice Address - Fax:734-528-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty