Provider Demographics
NPI:1043446537
Name:ISPINE PLLC
Entity type:Organization
Organization Name:ISPINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PRIBIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-260-6279
Mailing Address - Street 1:1188 COMMERCE PARK DR.
Mailing Address - Street 2:STE#2003
Mailing Address - City:ALTAMONTE , SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:407-357-0635
Mailing Address - Fax:407-483-4883
Practice Address - Street 1:23077 GREENFIELD ROAD
Practice Address - Street 2:SUITE 280
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-996-8714
Practice Address - Fax:248-595-8047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISPINE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-10
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97619207T00000X
TXM5448207T00000X
MI4301111900207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B31159Medicare UPIN