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General NPI Number Information
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NPI Number | 1649464686
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Entity Type | Organization
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Legal Business Name | MICHIGAN SPINE & JOINT CENTER P.C.
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 32500 23 MILE RD
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City | CHESTERFIELD
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State | MI
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Zip | 48047-1991
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Country | US
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Telephone | 158-672-5310
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Fax | 158-672-5315
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Provider Business Mailing Address
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Address Line | 32500 23 MILE RD
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City | CHESTERFIELD
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State | MI
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Zip | 48047-1991
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Country | US
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Telephone | 158-672-5310
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Fax | 158-672-5315
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | MRS. KATHY SMITH
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Credential |
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Telephone | 15867256100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 4301074605
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License Number State | MI
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