Provider Demographics
NPI:1649464686
Name:MICHIGAN SPINE & JOINT CENTER P.C.
Entity type:Organization
Organization Name:MICHIGAN SPINE & JOINT CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1586-725-6100
Mailing Address - Street 1:32500 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1991
Mailing Address - Country:US
Mailing Address - Phone:158-672-5310
Mailing Address - Fax:158-672-5315
Practice Address - Street 1:32500 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1991
Practice Address - Country:US
Practice Address - Phone:158-672-5310
Practice Address - Fax:158-672-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010746052081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJG407472OtherBCBS OF MICHIGAN
MI0P51700Medicare UPIN
MIJG407472OtherBCBS OF MICHIGAN
MIP51700006Medicare UPIN