Healthcare Provider Details

I. General information

NPI: 1467683953
Provider Name (Legal Business Name): UNIVERSITY NEUROSURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32500 23 MILE RD
CHESTERFIELD MI
48047-1991
US

IV. Provider business mailing address

29275 NORTHWESTERN HWY STE 100
SOUTHFIELD MI
48034-1044
US

V. Phone/Fax

Practice location:
  • Phone: 877-784-3667
  • Fax: 248-869-3982
Mailing address:
  • Phone: 877-784-3667
  • Fax: 248-869-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT R JOHNSON
Title or Position: PRESIDENT
Credential: MD
Phone: 877-784-3667