Healthcare Provider Details

I. General information

NPI: 1144650391
Provider Name (Legal Business Name): ACCUSPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2013
Last Update Date: 11/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 PARK ST
BIRMINGHAM MI
48009-3424
US

IV. Provider business mailing address

PO BOX 3837
CAROL STREAM IL
60132-3837
US

V. Phone/Fax

Practice location:
  • Phone: 214-615-5168
  • Fax:
Mailing address:
  • Phone: 214-615-5167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number4301088960
License Number StateMI

VIII. Authorized Official

Name: MS. MELANIE GROSS
Title or Position: VP OF REVENUE CYCLE SOLUTIONS
Credential:
Phone: 214-615-5168