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General NPI Number Information
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NPI Number | 1700909843
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Entity Type | Organization
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Legal Business Name | MICHIGAN NEURODIAGNOSTICS, PC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 15142 LEVAN RD
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City | LIVONIA
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State | MI
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Zip | 48154-5027
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Country | US
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Telephone | 734-779-2147
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Fax | 734-779-2160
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Provider Business Mailing Address
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Address Line | 15142 LEVAN RD
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City | LIVONIA
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State | MI
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Zip | 48154-5027
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Country | US
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Telephone | 734-779-2147
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Fax | 734-779-2160
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SALEEM A. TAHIR
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Credential | M.D.
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Telephone | 734-779-2147
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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 | ST039317
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License Number State | MI
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