Healthcare Provider Details

I. General information

NPI: 1447822135
Provider Name (Legal Business Name): MICHIGAN CENTER FOR NEUROPSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11368 ALLEN RD
TAYLOR MI
48180-4372
US

IV. Provider business mailing address

11368 ALLEN RD
TAYLOR MI
48180-4372
US

V. Phone/Fax

Practice location:
  • Phone: 313-283-6056
  • Fax: 248-694-2022
Mailing address:
  • Phone: 313-283-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAMZI HASSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 313-283-6056