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General NPI Number Information
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NPI Number | 1689879629
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Entity Type | Organization
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Legal Business Name | MICHIGAN NEUROLOGY, P.L.L.C.
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 1030 HARRINGTON ST SUITE 205
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2967
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Country | US
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Telephone | 586-493-3188
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Fax | 586-493-3191
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Provider Business Mailing Address
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Address Line | 1030 HARRINGTON ST SUITE 205
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2967
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Country | US
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Telephone | 586-493-3188
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Fax | 586-493-3191
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JULIE ANNE-MARIE BURNHAM
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Credential | D.O.
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Telephone | 586-493-3188
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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 | JH012296
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License Number State | MI
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