Healthcare Provider Details

I. General information

NPI: 1811300155
Provider Name (Legal Business Name): NEUROLOGY & PAIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 7TH ST STE C
PORT HURON MI
48060-5497
US

IV. Provider business mailing address

1103 7TH ST STE C
PORT HURON MI
48060
US

V. Phone/Fax

Practice location:
  • Phone: 810-990-6880
  • Fax: 810-990-6881
Mailing address:
  • Phone: 810-990-6880
  • Fax: 810-990-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARWAN SHUAYTO
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 810-989-6880