MEDICARE: SPINE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	4301088960	MI

General Provider Information

NPI Number	:	1134329493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE, PLLC

Provider Business Mailing Address
First Line	:	1221 BOWERS ST UNIT 2710
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48012-7106
Country	:	US
Telephone Number	:	248-566-3313
Fax Number	:	248-566-3316

Provider Business Practice Location Address
First Line	:	555 BARCLAY CIR STE 140
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4587
Country	:	US
Telephone Number	:	248-566-3313
Fax Number	:	248-566-3316

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY K WINGATE
Credential	:	MD
Telephone Number	:	248-228-0054

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	10/17/2019

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