Healthcare Provider Details

I. General information

NPI: 1437776689
Provider Name (Legal Business Name): NEUROSPINE COVERAGE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13530 MICHIGAN AVE
DEARBORN MI
48126-3574
US

IV. Provider business mailing address

29425 NORTHWESTERN HWY SUITE 202
SOUTHFIELD MI
48034-1080
US

V. Phone/Fax

Practice location:
  • Phone: 313-463-8676
  • Fax:
Mailing address:
  • Phone: 248-809-3240
  • Fax:

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 Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: FARHAN SIDDIQ
Title or Position: OWNER
Credential: MD
Phone: 248-809-3240