Provider Demographics
NPI:1992011332
Name:UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Other - Org Name:MICHIGAN HEAD AND SPINE INSTITUTE
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 1:6200 N HAGGERTY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3605
Mailing Address - Country:US
Mailing Address - Phone:877-784-3667
Mailing Address - Fax:248-869-3982
Practice Address - Street 1:6200 N HAGGERTY RD
Practice Address - Street 2:STE 200
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3605
Practice Address - Country:US
Practice Address - Phone:877-784-3667
Practice Address - Fax:248-869-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI140F329410OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0Q26462Medicare PIN