Organization
NEUROSURGERY GROUP, P.C.
Active
Other names
Wellness Physical Medicine Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARIE THERESA CHISHOLM (PRACTICE MANAGER)
(586) 412-8566
Entity
Organization
Contact information
Practice address
43650 GARFIELD, CLINTON TWP, MI 48038-6332
(586) 263-0820
(586) 263-3819
Mailing address
43650 GARFIELD, CLINTON TWP, MI 48038-6332
(586) 263-0820
(586) 263-3819
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
028777
MI
207T00000X
Neurological Surgery Physician
052399
MI
208100000X
Physical Medicine & Rehabilitation Physician
405324
MI
2084N0400X
Neurology Physician
051833
MI
363AM0700X
Medical Physician Assistant
5601002721
MI
363AM0700X
Medical Physician Assistant
5601003971
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437099
—
MI
05
—
1891095
—
MI
05
—
4815088
—
MI
05
—
4815097
—
MI
Enumeration date
09/28/2006
Last updated
08/19/2008
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