Healthcare Provider Details

I. General information

NPI: 1518588078
Provider Name (Legal Business Name): MACKINAC NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 CEDAR CT
MACKINAC ISLAND MI
49757
US

IV. Provider business mailing address

PO BOX 2005
MACKINAC ISLAND MI
49757-2005
US

V. Phone/Fax

Practice location:
  • Phone: 906-430-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER ROBERT SPITZER
Title or Position: OWNER
Credential: MD
Phone: 248-505-2525