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General NPI Number Information
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NPI Number | 1467576132
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Entity Type | Organization
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Legal Business Name | NORTHWEST NEUROLOGY PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 27200 LAHSER RD SUITE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2137
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Country | US
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Telephone | 248-208-9215
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Fax | 248-208-9217
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Provider Business Mailing Address
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Address Line | 27200 LAHSER RD SUITE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2137
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Country | US
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Telephone | 248-208-9215
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Fax | 248-208-9217
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TESSY C JENKINS
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Credential | MD
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Telephone | 248-208-9215
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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 | 4301058568
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License Number State | MI
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