1457763773 NPI number — MICHIGAN SPINE MANAGEMENT CLINIC PLC

Table of content: JEAN CLARE SMITH MD (NPI 1528130416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457763773 NPI number — MICHIGAN SPINE MANAGEMENT CLINIC PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN SPINE MANAGEMENT CLINIC PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457763773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 N TELEGRAPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48128-1619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-406-6002
Provider Business Mailing Address Fax Number:
313-406-6484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 N TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48128-1619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-406-6002
Provider Business Practice Location Address Fax Number:
313-406-6484
Provider Enumeration Date:
05/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RAYCHOUNI
Authorized Official First Name:
MOHAMED
Authorized Official Middle Name:
JAMAL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-406-6002

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301010126 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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