Healthcare Provider Details

I. General information

NPI: 1891936977
Provider Name (Legal Business Name): COMPREHENSIVE CLINICAL NEUROLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 05/11/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28075 RANCHWOOD DR
SOUTHFIELD MI
48076-2401
US

IV. Provider business mailing address

28075 RANCHWOOD DR
SOUTHFIELD MI
48076-2401
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-8737
  • Fax: 248-559-7283
Mailing address:
  • Phone: 248-559-8737
  • Fax: 248-559-7283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDG050339
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID GASTON
Title or Position: DR
Credential: MD
Phone: 248-559-8737