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General NPI Number Information
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NPI Number | 1649640830
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Entity Type | Organization
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Legal Business Name | MICHIGAN SPINE AND BRAIN INSTITUTE
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 5400 MACKINAW RD SUITE 2300
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City | SAGINAW
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State | MI
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Zip | 48604-9515
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Country | US
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Telephone | 989-753-4000
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Fax | 989-754-4000
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Provider Business Mailing Address
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Address Line | 5400 MACKINAW RD SUITE 2300
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City | SAGINAW
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State | MI
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Zip | 48604-9515
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Country | US
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Telephone | 989-753-4000
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Fax | 989-754-4000
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Authorized Official
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Title or Position | OWNER
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Name | MARK S ADAMS
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Credential | MD
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Telephone | 989-753-4000
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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 | MA059379
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License Number State | MI
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