Provider Demographics
NPI:1801371380
Name:JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Entity Type:Organization
Organization Name:JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGANNATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-733-9904
Mailing Address - Street 1:DEPT 771749 PO BOX 77000
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 W HARRIE ST FL 2
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-1209
Practice Address - Country:US
Practice Address - Phone:989-701-2538
Practice Address - Fax:989-701-2540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1447299797Medicaid