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General NPI Number Information
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NPI Number | 1699761379
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Entity Type | Organization
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Legal Business Name | UNIVERSITY NEUROSURGICAL ASSOCIATES PC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 29275 NORTHWESTERN HWY STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1044
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Country | US
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Telephone | 248-784-3708
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Fax | 248-784-3743
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Provider Business Mailing Address
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Address Line | 29275 NORTHWESTERN HWY STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1044
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Country | US
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Telephone | 877-784-3667
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Fax | 248-784-3743
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT R JOHNSON
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Credential | M.D.
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Telephone | 877-784-3667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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