MEDICARE: FAMILY NEUROLOGY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1477967313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY NEUROLOGY PLLC

Provider Business Mailing Address
First Line	:	1124 KINMORE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1124 KINMORE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3413
Country	:	US
Telephone Number	:	313-566-3880
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	YOUSSEF DAKKA
Credential	:
Telephone Number	:	313-566-3880

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	06/24/2014

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