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General NPI Number Information
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NPI Number | 1043446537
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Entity Type | Organization
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Legal Business Name | ISPINE PLLC
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD ROAD SUITE 280
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 248-996-8714
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Fax | 248-595-8047
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Provider Business Mailing Address
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Address Line | 1188 COMMERCE PARK DR. STE#2003
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City | ALTAMONTE , SPRINGS
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State | FL
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Zip | 32714
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Country | US
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Telephone | 407-357-0635
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Fax | 407-483-4883
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEFAN GEORGE PRIBIL
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Credential | MD
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Telephone | 832-260-6279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME97619
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 4301111900
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | M5448
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License Number State | TX
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