Healthcare Provider Details

I. General information

NPI: 1164796405
Provider Name (Legal Business Name): UNIVERSITY NEUROSURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEADOWBROOK RD STE 150
NOVI MI
48375-1880
US

IV. Provider business mailing address

25500 MEADOWBROOK RD STE 150
NOVI MI
48375-1880
US

V. Phone/Fax

Practice location:
  • Phone: 248-784-3667
  • Fax: 248-869-3982
Mailing address:
  • Phone: 248-784-3667
  • 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 JOHNSON
Title or Position: PRESIDENT
Credential: MD
Phone: 248-784-3667