Provider Demographics
NPI:1548660848
Name:MICHIGAN SPINE AND BRAIN SURGERY PLLC
Entity type:Organization
Organization Name:MICHIGAN SPINE AND BRAIN SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVEKANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAVALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-6430
Mailing Address - Street 1:G3239 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3616
Mailing Address - Country:US
Mailing Address - Phone:810-733-7560
Mailing Address - Fax:
Practice Address - Street 1:G3239 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3616
Practice Address - Country:US
Practice Address - Phone:810-733-7560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVP065576261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty