Provider Demographics
NPI:1760687487
Name:SPINE SPECIALIST OF MICHIGAN PC
Entity Type:Organization
Organization Name:SPINE SPECIALIST OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:RADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-497-9477
Mailing Address - Street 1:32406 FRANKLIN RD UNIT 250493
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-7016
Mailing Address - Country:US
Mailing Address - Phone:248-497-9477
Mailing Address - Fax:248-865-4231
Practice Address - Street 1:32270 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-792-9496
Practice Address - Fax:248-792-9628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF7468OtherMEDICARE RAILROAD
0P42130Medicare PIN
DF7468OtherMEDICARE RAILROAD