Healthcare Provider Details

I. General information

NPI: 1356668610
Provider Name (Legal Business Name): MICHIGAN INSTITUTE OF NEUROLOGICAL DISEASES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PAGE AVE SUITE B
JACKSON MI
49201-2462
US

IV. Provider business mailing address

5091 OAK TREE CT
ANN ARBOR MI
48108-8573
US

V. Phone/Fax

Practice location:
  • Phone: 517-795-1416
  • Fax: 517-787-4280
Mailing address:
  • Phone: 517-795-1416
  • Fax: 517-787-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301072378
License Number StateMI

VIII. Authorized Official

Name: DR. UMESH VERMA
Title or Position: OWNER/MEDICAL PHYSICIAN
Credential: M.D.
Phone: 517-990-5331