Provider Demographics
NPI:1952000523
Name:CENTER FOR MINIMALLY INVASIVE NEUROSURGERY PLLC
Entity Type:Organization
Organization Name:CENTER FOR MINIMALLY INVASIVE NEUROSURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-961-7507
Mailing Address - Street 1:1020 RIVERWOOD CT STE 305
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2974
Mailing Address - Country:US
Mailing Address - Phone:832-447-7494
Mailing Address - Fax:832-510-0563
Practice Address - Street 1:1020 RIVERWOOD CT STE 305
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2974
Practice Address - Country:US
Practice Address - Phone:832-447-7494
Practice Address - Fax:832-510-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty