Healthcare Provider Details

I. General information

NPI: 1982149738
Provider Name (Legal Business Name): MICHIGAN NEURODIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27209 LAHSER RD STE 130
SOUTHFIELD MI
48034-8401
US

IV. Provider business mailing address

600 LAS COLINAS BLVD E STE 2000
IRVING TX
75039-5607
US

V. Phone/Fax

Practice location:
  • Phone: 313-263-3275
  • Fax: 866-279-4704
Mailing address:
  • Phone: 469-995-8416
  • Fax: 866-279-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ALVAREZ
Title or Position: CEO
Credential:
Phone: 469-995-8416