Healthcare Provider Details

I. General information

NPI: 1902465958
Provider Name (Legal Business Name): ERIC ROBERT MONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COOPER AVE STE 4100
SAGINAW MI
48602-5182
US

IV. Provider business mailing address

101 CURRY AVE UNIT 518
ROYAL OAK MI
48067-4233
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301514867
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: