1760521298 NPI number — MICHIGAN BRAIN & SPINE INSTITUTE, PC

Table of content: MISS MEGA MARGAPURAM DMD (ANTICIPATED) (NPI 1073001558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760521298 NPI number — MICHIGAN BRAIN & SPINE INSTITUTE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN BRAIN & SPINE INSTITUTE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760521298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5315 ELLIOTT DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-8634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-434-4110
Provider Business Mailing Address Fax Number:
734-528-0987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5315 ELLIOTT DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-8634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-434-4110
Provider Business Practice Location Address Fax Number:
734-528-0987
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MACKINNON
Authorized Official First Name:
KELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
734-434-4110

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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