Michigan Spine & Joint Center P.C.
Organization Active NPI Pain Medicine (Physical Medicine & Rehabilitation) Physician · Chesterfield, MI
NPI 1649464686 · NPPES record last updated Dec 2, 2008
Key facts
- NPI
- 1649464686
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X
- License
- 4301074605 (MI)
- Legal business name
- MICHIGAN SPINE & JOINT CENTER P.C.
- Practice address
- 32500 23 Mile Rd
Chesterfield, MI 48047-1991 - Phone
- (158) 672-5310
- Fax
- (158) 672-5315
- NPI assigned
- Sep 4, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Kathy Smith
- Title
- Insurance Manager
- Phone
- (586) 725-6100
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 7
-
Barry J Gross, D.O.
-
Srinivasa Rao Gude, RPT
-
Thomas J Neuner, DC
-
Erica Lynn Selby- Cook, D.C.
-
Irshath Mohamed Zackariya, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080117000256 | MI | Part B Supplier - Clinic/Group Practice | 7012098940 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chesterfield, MI |
National Provider Directory
- Tax ID family
- Michigan Spine Joint Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Physical Medicine & Rehabilitation) Physician |
2081P2900X | 4301074605 | MI | Yes |
Addresses
Primary practice location
32500 23 Mile Rd
Chesterfield, MI 48047-1991
Mailing address
32500 23 Mile Rd
Chesterfield, MI 48047-1991
Phone (158) 672-5310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| JG407472 | Other | MI | BCBS OF MICHIGAN |
Other providers in Chesterfield, MI
- Marykay Meyering
- Michael Mianecki
- Thomas L Mianecki
- Lauren Michael
- Michigan Spine & Joint Center P.C.
- Michigan Spine and Joint Center
- Kylie Mickley
- Abagail Middlebrook
- Melody Moenay Middlebrooks
- Milford Medical Supplies
All providers in Chesterfield, MI · Pain Medicine (Physical Medicine & Rehabilitation) Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.