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General NPI Number Information
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NPI Number | 1033548581
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Entity Type | Organization
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Legal Business Name | MICHIGAN NEUROSCIENCE CLINIC PLLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 11780 TELEGRAPH RD STE 100
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City | TAYLOR
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State | MI
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Zip | 48180-6862
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Country | US
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Telephone | 734-374-1112
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Fax | 734-374-1119
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Provider Business Mailing Address
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Address Line | PO BOX 86
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City | TAYLOR
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State | MI
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Zip | 48180-0086
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Country | US
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Telephone | 734-374-1112
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Fax | 734-374-1119
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Authorized Official
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Title or Position | OWNER
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Name | OMAR AHMAD
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Credential | M.D.
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Telephone | 313-231-4460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301093212
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301092682
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License Number State | MI
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