Provider Demographics
NPI:1649640830
Name:MICHIGAN SPINE AND BRAIN INSTITUTE
Entity type:Organization
Organization Name:MICHIGAN SPINE AND BRAIN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-753-4000
Mailing Address - Street 1:5400 MACKINAW RD
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9515
Mailing Address - Country:US
Mailing Address - Phone:989-753-4000
Mailing Address - Fax:989-754-4000
Practice Address - Street 1:5400 MACKINAW RD
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9515
Practice Address - Country:US
Practice Address - Phone:989-753-4000
Practice Address - Fax:989-754-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMA059379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty