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General NPI Number Information
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NPI Number | 1992261481
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Entity Type | Organization
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Legal Business Name | LUCID NEUROLOGY
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 26222 TELEGRAPH ROAD SUITE 300
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City | SOUTHFIELD
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State | MI
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Zip | 48033
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Country | US
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Telephone | 248-864-8752
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Fax | 248-920-0744
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Provider Business Mailing Address
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Address Line | 26222 TELEGRAPH ROAD SUITE 300
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City | SOUTHFIELD
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State | MI
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Zip | 48033
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Country | US
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Telephone | 248-864-8752
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Fax | 248-920-0744
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Authorized Official
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Title or Position | MANAGER/AUTHORIZED OFFICAL
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Name | KEVIN KACHAN
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Credential |
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Telephone | 248-250-3393
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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 |
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