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General NPI Number Information
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NPI Number | 1427208768
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Entity Type | Organization
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Legal Business Name | SOUTHEAST MICHIGAN BRAIN AND SPINE SURGERY, PLLC
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 4800 S SAGINAW ST SUITE 1800
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City | FLINT
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State | MI
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Zip | 48507-2669
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Country | US
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Telephone | 810-732-8336
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Fax | 810-239-4346
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Provider Business Mailing Address
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Address Line | 4800 S SAGINAW ST SUITE 1800
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City | FLINT
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State | MI
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Zip | 48507-2669
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Country | US
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Telephone | 810-732-8336
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Fax | 810-239-4346
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | RKIA ELAOUFIR
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Credential |
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Telephone | 810-732-8336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301093301
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License Number State | MI
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