Healthcare Provider Details

I. General information

NPI: 1437345915
Provider Name (Legal Business Name): THE NEUROSURGERY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5448 15 MILE RD
STERLING HEIGHTS MI
48310-5111
US

IV. Provider business mailing address

43650 GARFIELD RD
CLINTON TOWNSHIP MI
48038-1120
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-0820
  • Fax:
Mailing address:
  • Phone: 586-263-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4301405324
License Number StateMI

VIII. Authorized Official

Name: DR. MARK J BRENNAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 586-263-0820