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General NPI Number Information
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NPI Number | 1578934600
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE NEUROLOGY , PLLC
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 21700 NORTHWESTERN HWY STE 150
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4906
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Country | US
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Telephone | 248-232-7422
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Fax | 248-232-7421
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Provider Business Mailing Address
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Address Line | 44648 MOUND RD STE 131
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1322
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Country | US
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Telephone | 248-232-7422
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Fax | 248-232-7421
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Authorized Official
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Title or Position | MANAGER
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Name | MARINA LJUCOVIC
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Credential |
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Telephone | 419-777-8260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301087670
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License Number State | MI
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