Healthcare Provider Details

I. General information

NPI: 1427208768
Provider Name (Legal Business Name): SOUTHEAST MICHIGAN BRAIN AND SPINE SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST SUITE 1800
FLINT MI
48507-2669
US

IV. Provider business mailing address

4800 S SAGINAW ST SUITE 1800
FLINT MI
48507-2669
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-8336
  • Fax: 810-239-4346
Mailing address:
  • Phone: 810-732-8336
  • Fax: 810-239-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301093301
License Number StateMI

VIII. Authorized Official

Name: RKIA ELAOUFIR
Title or Position: BILLING SPECIALIST
Credential:
Phone: 810-732-8336