Healthcare Provider Details

I. General information

NPI: 1073464152
Provider Name (Legal Business Name): M SPINE & JOINT SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3174 SIENNA DR S SUITE 102
FARGO ND
58104
US

IV. Provider business mailing address

3174 SIENNA DR S SUITE 102
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 701-248-8126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROHIT MAHAJAN
Title or Position: PRESIDENT
Credential: MD
Phone: 562-754-0201