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NPI Code Detail

MEDICARE: JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC

MEDICARE: JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207T00000XNeurological Surgery Physician

General Provider Information

NPI Number : 1093521080
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Provider Business Mailing Address
First Line : DEPT 771749 PO BOX 77000
Second Line :
City : DETROIT
State : MI
Zip : 48277
Country : US
Telephone Number : 989-308-1840
Fax Number :
Provider Business Practice Location Address
First Line : 1221 SOUTH DR
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-3257
Country : US
Telephone Number : 989-308-1840
Fax Number : 989-391-4170
Authorized Official
Title or Position : PRESIDENT
Name : JAYANT JAGANNATHAN
Credential :
Telephone Number : 248-733-9904
Provider Enumeration Date : 12/05/2024
Last Update Date : 12/05/2024

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Directions to “JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC ” Practice Location

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