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General NPI Number Information
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NPI Number | 1669611059
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Entity Type | Organization
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Legal Business Name | COVENANT NEUROLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3750
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Country | US
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Telephone | 248-569-5476
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Fax |
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Provider Business Mailing Address
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Address Line | 4245 S BEECH DALY ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-1567
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. CHARISE VALENTINE
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Credential | M. D.
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Telephone | 248-569-5476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 4301053752
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License Number State | MI
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