Healthcare Provider Details

I. General information

NPI: 1407175102
Provider Name (Legal Business Name): SYNAPSE NEURODIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6418 MISSION CT
W BLOOMFIELD MI
48324-1398
US

IV. Provider business mailing address

6418 MISSION CT
W BLOOMFIELD MI
48324-1398
US

V. Phone/Fax

Practice location:
  • Phone: 248-330-3520
  • Fax: 248-856-1770
Mailing address:
  • Phone: 248-330-3520
  • Fax: 488-561-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY LUKASIK
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 248-330-3520