Provider Demographics
NPI:1124353727
Name:MICHIGAN SPINE AND BRAIN INSTITUTE PC
Entity type:Organization
Organization Name:MICHIGAN SPINE AND BRAIN INSTITUTE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-753-4000
Mailing Address - Street 1:5400 MACKINAW RD
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9515
Mailing Address - Country:US
Mailing Address - Phone:989-753-4000
Mailing Address - Fax:989-754-4000
Practice Address - Street 1:5400 MACKINAW RD
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9515
Practice Address - Country:US
Practice Address - Phone:989-753-4000
Practice Address - Fax:989-754-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059376207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6690490001OtherPTAN
MI4647680Medicaid
MIM74750097Medicare PIN
MIG84457Medicare UPIN