NPIMap

Organization Active NPI

Eastside Neurosurgery PC

  • Specialist
  • Detroit, MI
National Provider Identifier
1952596926
Registry record updated Dec 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
4301406954 Issued in MI
Legal business name
EASTSIDE NEUROSURGERY PC
Practice address
22201 Moross Rd
Suite 352
Detroit, MI 48236-2169
Phone
(313) 343-7900
Fax
(313) 343-7001
NPI assigned
Sep 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2010

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

Authorized official

Name
Dr. Susan A Graham
Title
Manager
Phone
(313) 343-8833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 4301406954 MI Primary

Addresses

Primary practice location

22201 Moross Rd
Suite 352
Detroit, MI 48236-2169

Mailing address

22201 Moross Rd
Suite 352
Detroit, MI 48236-2169
Phone (313) 343-7900

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291939200000",
    "number": "1952596926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22201 MOROSS RD",
            "address_2": "SUITE 352",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362169",
            "telephone_number": "313-343-7900",
            "fax_number": "313-343-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22201 MOROSS RD",
            "address_2": "SUITE 352",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362169",
            "telephone_number": "313-343-7900",
            "fax_number": "313-343-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE NEUROSURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2010-12-10",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "313-343-8833",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301406954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2010; 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.