Healthcare Provider Details

I. General information

NPI: 1700223617
Provider Name (Legal Business Name): NEUROLOGY AND SLEEP CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 STONE ST SUITE 1
PORT HURON MI
48060-3525
US

IV. Provider business mailing address

1117 STONE ST SUITE 1
PORT HURON MI
48060-3525
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-9699
  • Fax: 810-985-9694
Mailing address:
  • Phone: 810-985-9699
  • Fax: 810-985-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number4301076835
License Number StateMI

VIII. Authorized Official

Name: DR. NAGUIB I DEMIAN
Title or Position: OWNER
Credential: M.D.
Phone: 810-985-9699