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General NPI Number Information
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NPI Number | 1861498362
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Entity Type | Organization
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Legal Business Name | MICHIGAN NEUROLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 19699 E EIGHT MILE RD
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City | ST CLAIR SHORES
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State | MI
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Zip | 48080
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Country | US
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Telephone | 586-445-9900
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Fax | 586-776-4324
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Provider Business Mailing Address
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Address Line | 19699 E EIGHT MILE RD
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City | ST CLAIR SHORES
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State | MI
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Zip | 48080
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Country | US
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Telephone | 586-445-9900
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Fax | 586-776-4324
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Authorized Official
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Title or Position | PRESIDENT, MICHIGAN NEUROLOGY ASSOC
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Name | THOMAS GIANCARLO
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Credential | DO
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Telephone | 586-445-9900
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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 |
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License Number State | MI
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