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NPI Code Detail

MEDICARE: PEDIATRIC NEUROSURGERY GROUP, P.C.

MEDICARE: PEDIATRIC NEUROSURGERY GROUP, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207T00000XNeurological Surgery PhysicianMI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255476214
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC NEUROSURGERY GROUP, P.C.
Provider Business Mailing Address
First Line : 3901 BEAUBIEN ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-745-0659
Fax Number : 313-833-4748
Provider Business Practice Location Address
First Line : 3901 BEAUBIEN ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-833-4490
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. LYNIQUE LECHELL WILLIAMS
Credential :
Telephone Number : 313-745-0659
Provider Enumeration Date : 02/20/2007
Last Update Date : 02/18/2026

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