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General NPI Number Information
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NPI Number | 1245734730
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Entity Type | Organization
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Legal Business Name | E.I. NEUROLOGY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 15945 19 MILE RD STE 106
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1147
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Country | US
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Telephone | 586-263-0610
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Fax | 586-263-0834
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Provider Business Mailing Address
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Address Line | 43781 STONEY LN
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-2259
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Country | US
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Telephone | 586-263-0610
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ELMOATAZ IBRAHIM
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Credential | MD
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Telephone | 612-298-1580
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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 | 4301094678
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License Number State | MI
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