MEDICARE: THE NEUROSURGERY GROUP

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	261QP2000X	Physical Therapy Clinic/Center	4301405324	MI

General Provider Information

NPI Number	:	1437345915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NEUROSURGERY GROUP

Provider Business Mailing Address
First Line	:	43650 GARFIELD RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1120
Country	:	US
Telephone Number	:	586-263-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	5448 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5111
Country	:	US
Telephone Number	:	586-263-0820
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MARK J BRENNAN
Credential	:	M.D.
Telephone Number	:	586-263-0820

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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