Healthcare Provider Details

I. General information

NPI: 1356680912
Provider Name (Legal Business Name): JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 W BIG BEAVER RD SUITE 150
TROY MI
48084-2903
US

IV. Provider business mailing address

3290 W BIG BEAVER RD SUITE 150
TROY MI
48084-2903
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-6527
  • Fax: 248-792-9106
Mailing address:
  • Phone: 248-792-6527
  • Fax: 248-792-9106

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 Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAYANT JAGANNATHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-792-6527