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General NPI Number Information
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NPI Number | 1508949140
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Entity Type | Organization
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Legal Business Name | MICHIGAN NEURO DIAGNOSTICS PC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 42621 GARFIELD STE 110
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038
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Country | US
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Telephone | 586-228-9065
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Fax | 586-228-9039
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Provider Business Mailing Address
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Address Line | PO BOX 380168
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-0061
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Country | US
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Telephone | 586-228-9065
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Fax | 586-228-9039
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARBARA GARRETT NELSON
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Credential | MD
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Telephone | 586-228-9065
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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 | BN041753
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 49561020
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License Number State | WI
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