Healthcare Provider Details

I. General information

NPI: 1699761379
Provider Name (Legal Business Name): UNIVERSITY NEUROSURGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29275 NORTHWESTERN HWY STE 100
SOUTHFIELD MI
48034-1044
US

IV. Provider business mailing address

29275 NORTHWESTERN HWY STE 100
SOUTHFIELD MI
48034-1044
US

V. Phone/Fax

Practice location:
  • Phone: 248-784-3708
  • Fax: 248-784-3743
Mailing address:
  • Phone: 877-784-3667
  • Fax: 248-784-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name: ROBERT R JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 877-784-3667