Organization Active NPI

Mi Neurosurgery Clinic PC

  • Neurological Surgery Physician
  • Grand Blanc, MI
National Provider Identifier
1114052628
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
5101012775 Issued in MI
Legal business name
MI NEUROSURGERY CLINIC PC
Practice address
3635 Genesys Pkwy
Grand Blanc, MI 48439-8070
Phone
(810) 606-7535
Fax
(810) 606-7510
NPI assigned
Feb 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dawn Tartaglione, DO
Title
Owner
Phone
(810) 424-2007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 5101012775 MI Primary

Addresses

Primary practice location

3635 Genesys Pkwy
Grand Blanc, MI 48439-8070

Mailing address

3495 S Center Rd
Burton, MI 48519-1455
Phone (810) 424-2007

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114052628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 S CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485191455",
            "telephone_number": "810-424-2007",
            "fax_number": "810-743-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398070",
            "telephone_number": "810-606-7535",
            "fax_number": "810-606-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MI NEUROSURGERY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TARTAGLIONE",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-424-2007",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MI",
            "license": "5101012775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.