Healthcare Provider Details

I. General information

NPI: 1952556078
Provider Name (Legal Business Name): MICHIGAN NEUROLOGY ASSOCIATES DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34025 HARPER AVE
CLINTON TWP MI
48035-3737
US

IV. Provider business mailing address

34025 HARPER AVE
CLINTON TWP MI
48035-3737
US

V. Phone/Fax

Practice location:
  • Phone: 586-445-9900
  • Fax:
Mailing address:
  • Phone: 586-445-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5101008571
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5101008581
License Number StateMI

VIII. Authorized Official

Name: THOMAS GIANCARLO
Title or Position: PRESIDENT, MNA
Credential: DO
Phone: 586-445-9900