Provider Demographics
NPI:1740796838
Name:SPINE.HEALTH, PLLC
Entity type:Organization
Organization Name:SPINE.HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-228-0054
Mailing Address - Street 1:1221 BOWERS ST UNIT 2710
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-7106
Mailing Address - Country:US
Mailing Address - Phone:248-396-7612
Mailing Address - Fax:248-566-3316
Practice Address - Street 1:15565 NORTHLAND DR W STE 304
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5313
Practice Address - Country:US
Practice Address - Phone:248-809-3631
Practice Address - Fax:248-642-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088960261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain