MI NEUROSURGERY CLINIC PC
Physician Assistant at Genesys Pkwy, Grand Blanc, MI

License number
Michigan 5601004125
Category
Nursing
Type
Physician Assistant
Owner
Name: DAWN TARTAGLIONE DO
Title: OWNER
Phone: (810) 424-2007
Address
Address 2
3635 Genesys Pkwy, Grand Blanc, MI 48439
3495 S Center Rd, Flint, MI 48519
National Provider ID: 1912049099
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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MI NEUROSURGERY CLINIC, PC

Grand Blanc, MI

Status:
Inactive
Registration:
Oct 17, 2003
Addresses:
3635 Genesys Pkwy, Grand Blanc, MI 48439 (Physical)
Michigan (Mailing)
State ID:
13004D
Business type:
Domestic Professional Service Corporation
Expiration:
7-15-2012
Agent:
Dawn Tartaglione, D.o

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