Healthcare Provider Details

I. General information

NPI: 1366895559
Provider Name (Legal Business Name): MICHIGAN NEUROLOGY ASSOCIATES DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11051 HALL RD STE 240
UTICA MI
48317-5735
US

IV. Provider business mailing address

34025 HARPER AVE
CLINTON TOWNSHIP MI
48035-3737
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-9900
  • Fax: 586-323-5051
Mailing address:
  • Phone: 586-445-9900
  • Fax: 586-445-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: THOMAS GIANCARLO
Title or Position: PRESIDENT, MNA
Credential: DO
Phone: 586-445-9900