Organization
JAGANNATHAN NEUROSURGICAL INSTITUTE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYANT JAGANNATHAN M.D. (PRESIDENT)
(248) 792-6527
Entity
Organization
Contact information
Practice address
3290 W BIG BEAVER RD, SUITE 150, TROY, MI 48084-2903
(248) 792-6527
(248) 792-9106
Mailing address
3290 W BIG BEAVER RD, SUITE 150, TROY, MI 48084-2903
(248) 792-6527
(248) 792-9106
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447299797
—
MI
05
—
P52980058
—
MI
Enumeration date
02/01/2013
Last updated
07/28/2023
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