Provider Demographics
NPI:1750498275
Name:GREATER MICHIGAN SPINE & NEUROLOGIC INSTITUTE, PC
Entity type:Organization
Organization Name:GREATER MICHIGAN SPINE & NEUROLOGIC INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-214-2166
Mailing Address - Street 1:4641 E PICKARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2189
Mailing Address - Country:US
Mailing Address - Phone:989-214-2166
Mailing Address - Fax:989-214-2163
Practice Address - Street 1:4641 E PICKARD ST STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2189
Practice Address - Country:US
Practice Address - Phone:989-214-2166
Practice Address - Fax:989-214-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI140D120050OtherBCBSM GROUP PIN
MI1454111555OtherBCBSM
MI1454111555OtherBCBSM