Provider Demographics
NPI:1679110142
Name:SPINE, BRAIN AND JOINT INSTITUTE
Entity type:Organization
Organization Name:SPINE, BRAIN AND JOINT INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUPI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-230-0113
Mailing Address - Street 1:5101 GATE PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7276
Mailing Address - Country:US
Mailing Address - Phone:904-374-3672
Mailing Address - Fax:904-813-7156
Practice Address - Street 1:5101 GATE PKWY STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7276
Practice Address - Country:US
Practice Address - Phone:904-374-3672
Practice Address - Fax:904-813-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty