MEDICARE: JAGANNATHAN NEUROSURGICAL INSTITUTE 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	207T00000X	Neurological Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154969004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	DEPT 771749 PO BOX 77000
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48277-2000
Country	:	US
Telephone Number	:	248-792-6527
Fax Number	:	248-792-9106

Provider Business Practice Location Address
First Line	:	4 COLUMBUS AVE STE 260
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-6476
Country	:	US
Telephone Number	:	989-308-1840
Fax Number	:	989-391-4170

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAYANT JAGANNATHAN
Credential	:	MD
Telephone Number	:	248-792-6527

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/06/2024

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