Healthcare Provider Details

I. General information

NPI: 1275728107
Provider Name (Legal Business Name): DOWNRIVER NEUROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17515 FORT ST
RIVERVIEW MI
48193-6630
US

IV. Provider business mailing address

17515 FORT ST
RIVERVIEW MI
48193-6630
US

V. Phone/Fax

Practice location:
  • Phone: 734-225-7770
  • Fax:
Mailing address:
  • Phone: 734-225-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301078496
License Number StateMI

VIII. Authorized Official

Name: DR. CHRISTOPHER JAMES WHITTY
Title or Position: PRESIDENT
Credential: M.D., PH.D.
Phone: 734-225-7770