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1043446537 NPI number — ISPINE PLLC

NPI Number: 1043446537
Health Care Provider/Practitioner: ISPINE PLLC

Information about “1043446537” NPI (ISPINE PLLC) exists in 1043446537 in HTML format HTML  |  1043446537 in plain Text format TXT  |  1043446537 in PDF (Portable Document Format) PDF  |  1043446537 in an XML format XML  formats.

NPI Number : 1043446537 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043446537",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "ISPINE PLLC",
    "ParentOrgTIN": null,
    "OrgName": "ISPINE PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1188 COMMERCE PARK DR.",
    "SecondLineMailingAddress": "STE#2003",
    "MailingAddressCityName": "ALTAMONTE , SPRINGS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32714",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "407-357-0635",
    "MailingAddressFaxNumber": "407-483-4883",
    "FirstLinePracticeLocationAddress": "23077 GREENFIELD ROAD",
    "SecondLinePracticeLocationAddress": "SUITE 280",
    "PracticeLocationAddressCityName": "SOUTHFIELD",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48075",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-996-8714",
    "PracticeLocationAddressFaxNumber": "248-595-8047",
    "EnumerationDate": "06/10/2009",
    "LastUpdateDate": "09/20/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PRIBIL",
    "AuthorizedOfficialFirstName": "STEFAN",
    "AuthorizedOfficialMiddleName": "GEORGE",
    "AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "832-260-6279",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207T00000X",
          "TaxonomyName": "Neurological Surgery Physician",
          "LicenseNumber": "ME97619",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207T00000X",
          "TaxonomyName": "Neurological Surgery Physician",
          "LicenseNumber": "4301111900",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207T00000X",
          "TaxonomyName": "Neurological Surgery Physician",
          "LicenseNumber": "M5448",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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