Healthcare Provider Details

I. General information

NPI: 1457794513
Provider Name (Legal Business Name): MICHIGAN CLINIC NEUROSURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 CABARET TRL S
SAGINAW MI
48603-2202
US

IV. Provider business mailing address

3160 CABARET TRL S
SAGINAW MI
48603-2202
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-8712
  • Fax: 989-799-0222
Mailing address:
  • Phone: 989-799-8712
  • Fax: 989-799-0222

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 Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GERALD R SCHELL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 989-799-8712