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1629953567 NPI number — ENSPA PLLC

NPI Number: 1629953567
Health Care Provider/Practitioner: ENSPA PLLC

Information about “1629953567” NPI (ENSPA PLLC) exists in 1629953567 in HTML format HTML  |  1629953567 in plain Text format TXT  |  1629953567 in PDF (Portable Document Format) PDF  |  1629953567 in an XML format XML  formats.

NPI Number : 1629953567 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629953567",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "NEUROSURGERY AND SPINE CARE PLLC",
    "ParentOrgTIN": null,
    "OrgName": "ENSPA PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1221 BOWERS ST UNIT 940",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BIRMINGHAM",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48012-7037",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-443-8942",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "34020 7 MILE RD STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LIVONIA",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48152-3093",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-480-5424",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/08/2025",
    "LastUpdateDate": "08/08/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ELTAHAWY",
    "AuthorizedOfficialFirstName": "HAZEM",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "313-443-8942",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207T00000X",
          "TaxonomyName": "Neurological Surgery Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP3300X",
          "TaxonomyName": "Pain Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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