Provider Demographics
NPI:1841628799
Name:UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:46325 W 12 MILE RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2456
Mailing Address - Country:US
Mailing Address - Phone:877-784-3667
Mailing Address - Fax:248-869-3982
Practice Address - Street 1:25100 KELLY RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4910
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:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26462Medicare PIN