Southeast Michigan Neurosurgery PLLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

4301050230 Issued in MI

Legal business name

SOUTHEAST MICHIGAN NEUROSURGERY PLLC

Practice address

3535 West 13 Mile Road
Suite 504
Royal Oak, MI 48073

Phone

(248) 551-3020

Fax

(248) 551-3019

NPI assigned

Dec 31, 2007

Organization subpart

No

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

Authorized official

Name

Karol Zakalik, M.D.NPI 1609867985

Title

President

Phone

(248) 551-3020

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13361/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Karol Zakalik, MD

  • Neurological Surgery Physician
  • Royal Oak, MI
  • NPI 1609867985
  Medicare reassignment NPD Authorized official
• Keith S Blum, DO

  • Neurological Surgery Physician
  • Las Vegas, NV
  • NPI 1558417345
  NPD (past)

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477008000000",
    "number": "1437334257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 WEST 13 MILE ROAD",
            "address_2": "SUITE 504",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "48073",
            "telephone_number": "248-551-3020",
            "fax_number": "248-551-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 WEST 13 MILE ROAD",
            "address_2": "SUITE 504",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "48073",
            "telephone_number": "248-551-3020",
            "fax_number": "248-551-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MICHIGAN NEUROSURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-31",
        "last_updated": "2016-10-21",
        "status": "A",
        "authorized_official_last_name": "ZAKALIK",
        "authorized_official_first_name": "KAROL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-551-3020",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "MI",
            "license": "4301050230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "140F344180",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2769781-10",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "PTAN P00455528",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DG8023",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "OP52120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Soulspace Wellness Center
• Maria Kathryn Souphis, DO
• Olivia Rose Souphis, MD
• Ravikumar Sourirajan, PT, DPT
• Marcy Lee Soutar, RN
• Jacob Brad Souva
• Aimee Christine Sova, LLMSW
• Lindsay Taylor Sova, CRNA
• Katherin Sowa
• Stephanie Spaniolo, PA-C

• Neurological Surgery Physician in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Neurological Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.